Feminist and medical ethics: two different approaches to contextual ethics

Feminist ethics and medical ethics are critical of contemporary moral theory in several similar respects. There is a shared sense of frustration with, the level of abstraction and generality that characterizes traditional philosophic work in ethics and a common commitment to including contextual details and allowing room for the personal aspects of relationships in ethical analysis. This paper explores the ways in which context is appealed to in feminist and medical ethics, the sort of details that should be included in the recommended narrative approaches to ethical problems, and the difference it makes to our ethical deliberations if we add an explicitly feminist political analysis to our discussion of context. It is claimed that an analysis of gender is needed for feminist medical ethics and that this requires a certain degree of gener-ality, i. e. a political understanding of context.     

Computers,information and ethics: A review of issues and literature

Editorial note:The following bibliographic survey of computer ethics is intended as a general introduction useful to guide both preliminary research and course development. It is the first of a series that Carl Mitcham will be doing on a number of specific discussions of ethics in science and technology. Future installments are projected on nuclear ethics, engineering ethics, ethics in scientific research, and biomedical ethics. With this [book] I issue “a call to arms.” The world needs much more discussion and writing on the social and ethical issues surrounding computing. I hope readers .... will take up the challenge.     

Hermeneutical clinical ethics: A commentary

Essays by Thomasma and ten Have recommend hermeneutical clinical ethics. The use Thomasma makes of hermeneutics is not radical enough because it leaves out basic interpretation of clinical practice and focuses narrowly on ethical principles and rules. Ten Have, while failing to notice that the hyperreality of clinical ethics is a feature of all language, rightly distinguishes four characteristic parameters of a thoroughgoing interpretive clinical ethics: experience, attitudes and emotions, community, and ambiguity. Suggestions are made for implementing hermeneutical ethics in clinical teaching.     

Human Rights,Cultural Pluralism,and International Health Research

In the field of bioethics, scholars have begun to consider carefully the impact of structural issues on global population health, including socioeconomic and political factors influencing the disproportionate burden of disease throughout the world. Human rights and social justice are key considerations for both population health and biomedical research. In this paper, I will briefly explore approaches to human rights in bioethics and review guidelines for ethical conduct in international health research, focusing specifically on health research conducted in resource-poor settings. I will demonstrate the potential for addressing human rights considerations in international health research with special attention to the importance of collaborative partnerships, capacity building, and respect for cultural traditions. Strengthening professional knowledge about international research ethics increases awareness of ethical concerns associated with study design and informed consent among researchers working in resource-poor settings. But this is not enough. Technological and financial resources are also necessary to build capacity for local communities to ensure that research results are integrated into existing health systems. Problematic issues surrounding the application of ethical guidelines in resource-poor settings are embedded in social history, cultural context, and the global political economy. Resolving the moral complexities requires a commitment to engaged dialogue and action among investigators, funding agencies, policy makers, governmental institutions, and private industry.     

Rethinking research ethics

Contemporary research ethics policies started with reflection on the atrocities perpetrated upon concentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research.     

Rethinking research ethics

Contemporary research ethics policies started with reflection on the atrocities perpetrated upon concentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research.     

A Methodologically Pragmatist Approach to Development Ethics

This paper suggests that lessons from the field of environmental ethics and sociological perspectives on knowledge are important tools for rethinking what type of ethical analysis is needed for building up further the field of development ethics and, more generally, for addressing some of the most fundamental ethical problems related to global poverty and development. The paper argues for a methodologically pragmatist approach to development ethics that focuses on the interplay between facts, values, concepts and practices. It views development ethics as a hybrid between a public moral–political philosophy and a public conception of social science. Ethical analyses of poverty and development must lead to fundamental changes in the ways knowledge is produced and justified and must challenge the dominance of global institutions and orthodox economics as the single sources of expert knowledge for development. Two of the main tasks of ethical analysis is to provide tools for the formulation of alternative knowledge for development centred on the equal moral worth of all human beings, and to influence global policy making as well as multilateral institutions' goals and policies. The last section of the paper argues that Amartya Sen's version of the Capability Approach is already methodologically pragmatist and points to some convergence between Sen's work and John Dewey's. Further sociological and methodologically pragmatist analysis of the approach is needed to assess the ways in which it is influencing debates on human development and leading to policy changes, and the possible distortions it suffers when adopted by multilateral agencies and policy makers.     

The science of ethics: Deception, the resilient self, and the APA code of ethics, 1966-1973

This paper has two aims. The first is to shed light on a remarkable archival source, namely survey responses from thousands of American psychologists during the 1960s in which they described their contemporary research practices and discussed whether the practices were "ethical." The second aim is to examine the process through which the American Psychological Association (APA) used these survey responses to create principles on how psychologists should treat human subjects. The paper focuses on debates over whether "deception" research was acceptable. It documents how members of the committee that wrote the principles refereed what was, in fact, a disagreement between two contemporary research orientations. The paper argues that the ethics committee ultimately built the model of "the resilient self" into the APA's 1973 ethics code. At the broadest level, the paper explores how prevailing understandings of human nature are written into seemingly universal and timeless codes of ethics.     

Learning for oneself: A Confucian‐inspired case for moral formation in ethics pedagogy

This article explores the disconnection between ethical theory and ethical practice in ethics courses at secular U.S. colleges and universities. In such contexts academic ethics focuses almost exclusively on “ethical reasoning” and leaves the business of practical moral formation of students in the realm of “student life.” I argue this disconnection is inevitable given the dominant understanding that moral formation must be guided by a consistent ethical theory, and must eventuate in certain prosocial behaviors, while norms of pluralism and free inquiry mandate that academic courses not attempt to dictate certain views or behaviors as normative. Drawing on the Confucian model of moral cultivation expressed by the early Chinese figure Mengzi, I argue for a different understanding of moral formation that focuses on open‐endedness, self‐direction, and the acquisition of skills in directing attention and will. This approach avoids the most serious challenges to practical moral formation in secular contexts, and I suggest some broadly applicable principles for implementing these ideas in ethics courses.     

The hyperreality of clinical ethics: A unitary theory and hermeneutics

Medical ethics nowadays is dominated by a conception of ethics as the application of moral theories and principles. This conception is criticized for its depreciation of the internal morality of medical practice and its narrow view of external morality. This view reflects both a lack of interest in the empirical realities of medicine and a neglect of the socio-cultural value-contexts of medical ethical issues, including the creative development of a broader philosophical framework for a practicable medical ethics. Several alternative approaches and conceptions have been proposed. The unified clinical ethics theory, developed by Graber and Thomasma, is an interesting attempt to synthesize these alternative approaches. It correctly identifies as the crucial problem the present disconnectedness of medical ethics from theoretical philosophy as well as the practice of medicine. In this paper, however, it is argued that the unitary theory should take more serious attention to the hermeneutic character of medicine as well as ethics. This implies that the unitary theory must in fact transform itself into aninterpretive clinical ethics theory. The theoretical characteristics and practical consequences of an interpretive theory of medical ethics are discussed in the present paper.     

Social ethics,the philosophy of medicine,and professional responsibility

The social ethics of medicine is the study and ethical analysis of social structures which impact on the provision of health care by physicians. There are many such social structures. Not all these structures are responsive to the influence of physicians as health professionals. But some social structures which impact on health care are prompted by or supported by important preconceptions of medical practice. In this article, three such elements of the philosophy of medicine are examined in terms of the negative impact on health care of the social structures to which they contribute. The responsibilities of the medical profession and of individual physicians to work to change these social structures are then examined in the light of a theory of profession.     

The personal is the organizational in the ethics of hospital social workers

Understanding the social context of clinical ethics is vital for making ethical discourse central in professional practice and for preventing harm. In this paper, we present findings about clinical ethics from in-depth interviews and consultation with 7 members of a hospital social work department. Workers gave different accounts of ethical dilemmas and resources for ethical decision making than did their managers, whereas workers and managers agreed on core-guiding ethical principles and on ideal situations for ethical discourse. We discuss the research team's initial interpretations, the relevance of the extant ethics literature to organizational structures and dynamics, and alternative perspectives on clinical ethics.     

Research ethics committees: a regional approach

Guidelines for Institutional Review Boards (IRBs) or research ethics committees exist at national and international levels. These guidelines are based on ethical principles and establish an internationally acceptable standard for the review and conduct of medical research. Having attained a multinational consensus about what these fundamental guidelines should be, IRBs are left to interpret the guidelines and devise their own means of implementing them. Individual and community values bear on the interpretation of the guidelines so different IRBs attain different levels of effectiveness. In the Caribbean and Pan American regions there are few IRBs. Obstacles to the establishment and function of IRBs are exacerbated in developing regions like these by differences in language, literacy, and local value systems; education, administrative expertise, facilities, and access to information are also limited. A regional IRB network might facilitate more uniform ethical review in developing countries, and simplify IRB procedures. This revised version was published online in August 2006 with corrections to the Cover Date.     

Cosmopolitan ethics and global legalism

This article analyses the legal and ethical dimensions of the wide gap between commitments to universal human rights and the reality of their widespread and systematic abuse, particularly as related to poverty and inequality. The argument put forward is that, properly conceived, global legalism, that is, the quest to apply the rule of law across and among states and societies, and cosmopolitan ethics, both support restricting harms imposed on weak and vulnerable individuals worldwide by an unjust institutional order. Therefore, those who have tended to value either a global rule of law or cosmopolitan ethics independently have good reason to pursue their requirements together. The article also considers the problem of legalism and cosmopolitanism being used by powerful agents in global politics to enhance their prerogatives and their freedoms from legal and ethical restraints.     

Toward a decolonial global ethics

This paper argues that decolonial theory can offer a distinctive and valuable ethical lens. Decolonial perspectives give rise to an ethics that is fundamentally global but distinct from, and critical of, moral cosmopolitanism. Decolonial ethics shares with cosmopolitanism a refusal to circumscribe normative commitments on the basis of existing political and cultural boundaries. It differs from cosmopolitanism, though, by virtue of its rejection of the individualism and universalism of cosmopolitan thought. Where cosmopolitan approaches tend to articulate abstract principles developed from within a particular Western tradition, decolonial approaches reject abstract global designs in favour of inter-cultural dialogue amongst multiple people(s), including peoples who deem collective and non-human entities to be of fundamental moral importance. In addition, decolonial global ethics rejects universality in favour of ‘pluriversality’.     

Contributions of empirical research to medical ethics

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine.     

儒家伦理与情感

The Confucian understanding of emotions and their ethical importance confirms and exemplifies the contemporary Western renewed understanding of the nature of emotions. By virtue of a systematic conceptual analysis of Confucian ethics, one can see that, according to Confucians, the ethical significance of emotions, lies in that an ethical life is also emotional and virtues are inclinational. And a further exploration shows that the reason for the ethical significance is both that emotions are heavenly-endowed and that there exists a union of emotions and reason in Confucian ethics. This will constitute a challenge to the so-called mainstream ethical theories which have been popularly engaged in seeking justifications for abstract moral rules. __________ Translated from Zhexue Yanjiu 哲学研究 (Philosophical Research), 2007, (3): 86–92     

Codes of medical ethics and the exportation of less-than-standard care

Recently a number of AIDS/AZT research studies, carried out by U.S. universities, have come under intense ethical scrutiny. In these studies, control groups of HIV-positive pregnant women were being given a placebo rather than AZT. Such research protocols would be illegal if practiced in the U.S. I examine a number of lamentable ethical lapses in the studies, and conclude that at least some of these ethical problems are traceable to a troubling contradiction between differing international codes of ethics. In a word, some international codes mandate that all research subjects (including control groups) receive the best standard of care available in the country sponsoring the research, while others suggest that providing only a "local" standard of care is ethically appropriate. I argue that these two ethical mandates cannot both be satisfied, and that host country populations will remain subject to exploitation unless this contradiction is resolved.     

Global ethics and principlism

This article examines the special relation between common morality and particular moralities in the four-principles approach and its use for global ethics. It is argued that the special dialectical relation between common morality and particular moralities is the key to bridging the gap between ethical universalism and relativism. The four-principles approach is a good model for a global bioethics by virtue of its ability to mediate successfully between universal demands and cultural diversity. The principle of autonomy (i.e., the idea of individual informed consent), however, does need to be revised so as to make it compatible with alternatives such as family- or community-informed consent. The upshot is that the contribution of the four-principles approach to global ethics lies in the so-called dialectical process and its power to deal with cross-cultural issues against the background of universal demands by joining them together.