Reflections on public bioethics: a view from the trenches

For many reasons, and more than its predecessors, the President's Council on Bioethics has been the subject of much public attention and heated controversy. But little of that attention and controversy has been informed by knowledge of the Council's mission, its ways of working, and, most importantly, its actual work. This essay describes the Council's mission, discusses its public ways of working, and reviews the five major works produced during the Council's first term. In all its activities, the Council has sought to develop a richer bioethics, one that recognizes and tries to do justice to the deep issues of our humanity raised by the age of biotechnology. Believing that these issues are properly matters to be discussed and governed by the polity as a whole, the Council also has sought to contribute to a genuinely public or political bioethics, beyond the rule of "experts," scientific and bioethical.     

Bioethics critically reconsidered: Living after foundations

Given intractable moral pluralism, what ought one to make of the bioethics that arose in the early 1970s, grounded as it was in the false assumption that there is a common secular morality that secular bioethics ought to apply? It is as if bioethics developed without recognition of the crisis at the heart of secular morality itself. Secular moral rationality cannot of itself provide the foundations to identify a particular morality and its bioethics as canonical. One is not just confronted with intractable moral and bioethical pluralism, but with the absence of a secular ground that can show why one should act morally rather than self-interestedly. The result is not merely the deflation of much of traditional Western morality to life-style and death-style choices, but the threat of deflating to political slogans the now-dominant secular morality, including its affirmation of human autonomy, equality, social justice, and human dignity. All of this invites one critically to reconsider the meaning and force of secular bioethics.     

Nature and grace: the paradox of Catholic ethics.

Roman Catholic bioethics seems to be caught in a paradox. On the one hand it is committed to the natural law tradition and the power of reason to understand the structures of creation and the moral law. On the other hand there is a greater and greater appeal to Scripture and revelation. The tradition maintains that reason is capable of understanding the rational structures of reality and that ethics is properly built on metaphysics. In this way ethics, bioethics, is non-sectarian. However, the tradition also recognizes the effects of Original Sin on the will and intellect and the broad cultural changes that have affected our understanding of metaphysics. The appeal to Revelation is a corrective to many contemporary trends in ethics and bioethics. This article will examine the interplay of reason and revelation in the Church's teaching on sexuality (particularly contraception and in vitro fertilization), suffering, and death. Catholic bioethics is in the end prophetic and ecumenical and not gnostic and non-ecumenical.     

The value of dignity in and for bioethics: rethinking the terms of the debate

The discussion of the nature and value of dignity in and for bioethics concerns not only the importance of the concept but also the aims of bioethics itself. Here, I challenge the claim that the concept of dignity is useless by challenging the implicit conception of usefulness involved. I argue that the conception of usefulness that both opponents and proponents of dignity in bioethics adopt is rooted in a narrow understanding of the role of normative theory in practical ethical thinking. I then offer an alternate understanding of the nature and value of dignity. I begin by recognizing that claims that one’s dignity has been violated point to an important difference between “respect for autonomy” and “respect for persons.” I then suggest three different conceptions of how dignity can be normatively guiding for bioethics, and conclude that, ultimately, understanding dignity as the cornerstone of a reflective perspective that frames moral reflection and deliberation is valuable for doing bioethics well.     

Prophecy,Ethical Constraints,and Unjust Silence

Cathleen Kaveny's Prophecy Without Contempt seeks to reorient the conversation among religious ethicists and political theorists about religion in public life. Rather than focus on religious speech in general, Kaveny distinguishes deliberation and indictment as forms of discourse, and she subjects indictment to ethical evaluation. She aims to constrain the public exercise of inordinate indictment, while encouraging prophetic indictment that meets the demands of justice. While the book is a much‐needed corrective, Kaveny's focus on the powerful rhetoric of prophetic indictment omits the harms that can come to the body politic from unjust silence. Such silence deserves more moral attention.     

人的尊严与生命伦理

“尊严”是频繁出现在生命伦理学中的一个概念,但关国学者麦克琳却在最近认为,尊严在生命伦理学中是个无用的概念,可以毫无损失地用其它概念,比如尊重人的自主性概念所代替。反驳了麦克琳的观点,定义了尊严的含义,认为生命伦理学的使命就是在当代生命科技高度发达的情况下如何尊重和保护人的尊严。     

Protection of Life and Human Dignity: The German Debate between Christian Norms and Secular Expectations

The German debate on bioethics and medical ethics turns on achange in the meaning of human dignity. Such dignity is increasinglyrendered contingent upon a person's empirically assessable qualityof life. In contrast to such dignity-endowed human life, a merelybiological human life is taken to disqualify its bearer fromsuch dignity, depriving his life of the protection "respectfor human dignity" would otherwise guarantee. The idea of a"life not worth living" or "undignified life" evokes categories,which were developed at the beginning of the 20th century, andlater informed the crimes of National Socialist medicine inGermany. Against this secular development, this article analysesthe theological and church-based discussion of basic bioethicalquestions in Germany, especially the controversy among Protestants:once Protestant ethicists abandon an explicitly theologicalbasis for their arguments, their conclusions come to closelyresemble those of the secular participants in the debate. Asa result, such Protestants relativize fundamental ethical norms.They subordinate, along with their secular environment, theprotection of life to respect for autonomy. They thus preparethe ground for a revival of the risky concepts of the past.     

Nanotechnologies, bioethics and human dignity

Nanoscale science, research, and technology present a complex set of circumstances. First of all, this field involves many different subjects, including biology, chemistry, physics, and environment sciences. Secondly, although scientists are working increasingly at a molecular level, nanotechnology is about much more than a reduction of scale. Indeed, nanoscience and Nanotechnologies offer an unprecedented ability to control and manipulate nature, offering hope for progress. Ethical perspectives vary considerably in this field, but commentators and researchers share a concern about a specific worrisome issue: the lack of appropriate ethical and legal principles and processes (associated with issues including health risks, human body manipulation, and private life violation), to guide nanotechnological R&D, commercialization, and final use. Some authors partially reject this concern by suggesting that Nanoscience and Nanotechnologies do not constitute an autonomous category, and that they are instead just the operative result of combining other traditional areas of study. However the nanotechnological debate brings up the semantic and content issues of bioethics and foments a contentious discussion emphasizing human dignity. Issues include enhancement versus therapeutic intervention, traceability versus privacy, and societal benefits versus risks. From these preliminary considerations, we will move on to discuss (I) the traditional, although still controversial, relationship between bioethics and human dignity, and (II) return to the subject of nanotechnology. We will discuss how today in Europe, although still indefinite, the principle of respect for human dignity is a welcomed contributor to "ethical vigilance" about the uncertain development of new nano-scale technologies. We will also note how U.S. strategy in this regard is simply lacking and appears only as a purely discursive "key issue in long term ".     

Death with dignity from the Confucian perspective

Death with dignity is a significant issue in modern bioethics. In modern healthcare, the wide use of new technologies at the end of life has caused heated debate on how to protect human dignity. The key point of contention lies in the different understandings of human dignity and the dignity of death. Human dignity has never been a clear concept in Western ethical explorations, and the dignity of death has given rise to more confusions. Although there is no such term as “dignity” in Confucian ethics, there are discussions of a number of ideas related to human dignity and the dignity of death. Therefore, Confucian bioethics can offer a new perspective for understanding the theoretical difficulties associated with the dignity of death and new methods for solving them. In this article, we attempt to reconstruct Confucian views on human dignity and the dignity of death and, based on those views, to analyze the following issues: the relationship between the dignity of death and biological life, the relationship between the dignity of death and suffering, the relationship between the dignity of death and the autonomy of human beings, and the relationship between the dignity of death and social justice. This article will also compare the Confucian views on these issues with the views of Western philosophers. Confucian ethics can offer distinct answers to the above issues and help resolve some confusions concerning concepts and theories in Western research on the dignity of death.     

The implausibility of appeals to human dignity: an investigation into the efficacy of notions of human dignity in the transhumanism debate

In recent decades, recourse to notions of human dignity has increased extensively within the field of bioethics. In particular, the notion has been utilised in arguments that seek to constrain a variety of biotechnological endeavours, examples of which include human cloning and transhumanism. In this regard, transhumanism is frequently described as an affront to human dignity in a manner that appears to be aimed at halting the possibility of further debate. The efficacy of the concept of human dignity has itself, however, been questioned. Criticisms include its ambiguous nature and thus the lack of adequate definition by those who utilise it, its supposedly religious undertones as well as the fact that it may be used to argue for diametrically opposing positions within the same argument, due to the existence of distinct and conflicting interpretations. In this paper, I briefly discuss the aims of the transhumanist movement and explicate the concept of human dignity in order to assess one of the most renowned dignity arguments that has been lodged against transhumanism, namely, the argument of the bioconservative thinker Leon Kass. In addition, I discuss the counter-argument of the transhumanist Nick Bostrom. These findings have implications for the concept's efficacy to adjudicate the complex ethical conundrums posed, not only by transhumanism, but in the bioethics arena in general.     

European Bioethics II--Disparate Hopes and Fears: An Introduction

This introduction supplies further bearing points for the conceptualmap, which the introduction to the previous issue on Europeanbioethics (2008/1) had provided for sorting out the variousdimension in which the essays collected in these issues resembleand differ from each other. Special attention is devoted tocommunication, as diverse Christianities attend to differentpurposes, problems, and opportunities for normatively engaging(persuading, influencing, ruling, opposing, and converting)their surrounding secularized cultures. These differences reflectincompatible ways of conceiving Christ's acts of healing, asthese provide a model for His disciples' bioethics. These differencesalso reflect diversely rationalist and noetic epistemologies.The subtext concerns the haunting question about the enduringsustainability of a specifically Christian bioethics in Europe.As Schotsmans opts for a Roman Catholicism that is not recognizedas such by his Magisterium, as Muller transforms Protestantisminto a religiously nonhostile laicity, as Messer and Silva daBarbosa hope for the prophetic impact of communal "cities onthe hill," and as the Orthodox pursue the conversion of WesternEurope in Greek, Russian, and Rumanian, ongoing Divine miraclespresent the most realistic hope.     

Examining the suitability of the principle of subsidiarity for bioethics

The political and social principle of subsidiarity can be useful as a general principle of bioethics. The principle states that only those decisions and tasks that cannot be effectively decided upon or performed by a supported or subsidized lower level authority ought to be relegated to a more central or higher authority. The concept of subsidiarity has been embedded tacitly in Western political thought for two millennia, but it has been articulated expressly only in the twentieth century. The principle has unique strengths: it is the only principle that addresses the issue of locus of decision making; it is strongly linked to human dignity, democracy, and solidarity; and it can assist in reaching agreements on the common good. There are also potential drawbacks that need to be taken into account when developing rules and guidelines for the principle's application in bioethics. The principle is particularly helpful in public health ethics, but it is also of use in the ethics of personal care and human research ethics.     

The word "bioethics": the struggle over its earliest meanings.

An article by Warren Reich in the December 1994 issue of this journal concludes that the word "bioethics" and the field of study it names experienced a "bilocated birth" in 1970/1971 under Van Rensselaer Potter, at the University of Wisconsin, and André Hellegers, at Georgetown University. Further historical inquiry confirms (1) that there were, from the start, some major differences -- even clashes -- between the Potter and the Hellegers/Georgetown understandings of bioethics; and (2) that the Hellegers/Georgetown approach came to be the more widely accepted meaning of the term, while Potter's idea of bioethics remained largely marginalized. However, this inquiry also results in a third, unanticipated, conclusion: that Hellegers (in contrast to the dominant model offered by the Georgetown scholars) actually proposed a global approach to bioethics, bringing his vision much closer to Potter's evolving view than previously has been acknowledged.     

Universalism, particularism and the ethics of dignity.

This paper explores the problem of universalism and particularism in contemporary ethics, and its relationship to Christian bioethics in particular. An ethic of human dignity is outlined, which, it is argued, constrains moral discourse in the broad sense--thus meeting the demands of universalism--but which is at the same time amenable to a variety of particularist interpretations--thus acknowledging the current shift toward historicism, traditionalism, and culture. The particularist interpretations that are of central concern here are those provided by historic Christianity. The eventual goal is to indicate how a Christian conception of human dignity can have universal normative relevance both as a standard against which to assess competing particularist conceptions, and as a practical guide for everyday living. A Christian conception of dignity will in turn have significant implications when addressing contemporary issues in bioethics. These are ambitious goals, and a full explication of the ideas presented will not be possible in this context. Nevertheless, there is value in getting a bird's-eye view of the landscape before one goes about scaling the mountains and exploring the valleys. The present essay is intended as a general geography of the moral terrain in which an ethic of dignity in general, and a Christian perspective on dignity in particular, can provide normative guidance.     

How Christian Norms Can Have an Impact on Bioethics in a Pluralist and Democratic Europe: A Scandinavian Perspective

This article assesses the similarity and difference betweenthe Western European style of doing bioethics and the Scandinavianone. First, it reviews the introductory article by the editor,C. Delkeskamp-Hayes in the first issue of Christian Bioethics(2008), devoted to the possibility of a specifically Christianbioethics in Europe. Second, it analyses bioethics debates inScandinavian today. In light of Delkeskamp-Hayes' article, themain similarity is that both regions are facing secularizationas a threat to basic Christian values, for example, to the Christianview of the sanctity and dignity of the human life. But theScandinavian tends to reduce Christian bioethics to Luther'sconcept of the worldly kingdom, supposed to foster a dialoguebetween Christians and non-Christians on controversial ethicalissues. Despite the positive value of the dialogue, this strategyrenders Christian ethics powerless. Third, from an evangelicaltheological standpoint, it proposes some strategies for enhancingthe influence of Christian commitments on bioethical laws andpolicies.     

The Convention on Human Rights and Biomedicine of the Council of Europe

The Convention on Human Rights and Biomedicine developed by the Council of Europe, now undergoing ratification, is the first international treaty focused on bioethics. This article describes the background of the Convention's development and its general provisions and provides a comparison of its requirements with those of federal regulations governing research with human subjects. Although most provisions are comparable, there are significant differences in scope and applicability, for example, in the areas of compensation for injury, research participation by persons with limited capacity to consent, assisted reproduction, organ transplantation, and research in emergency situations. The Convention represents a milestone in international bioethics and protection of human rights that will probably be referred to with increasing frequency.     

Human dignity – the foundation of political human rights? Empirical research among youth in Germany

This article focuses on political human rights and on the empirically assessed legitimation of these rights. This research considers the rights of refugees, the active and passive right to vote, and the right of protest. Given that the research is empirical research, respondents are requested to express agreement, disagreement or neutrality. The assumption is that contextual factors influence people’s assessment of rights. One contextual factor is, firstly, the concept of human dignity. International human rights covenants regard human dignity as the very foundation of all rights. That said, the concept of human dignity is subject to different understandings and – certainly in the past – the understanding of what constitutes human dignity has varied. Dignity can be related to the appreciation of the person given by others, to the moral behaviour of a person, and it can be understood as inherently related to the individual as a human being. It is this last understanding that forms the basis of modern declarations of human rights. Furthermore, the respondents’ value orientations and religious beliefs, along with society’s socio-political perception, will be examined to ascertain whether these factors have any influence on respondents’ attitudes towards political rights. The key question is: does human dignity influence people’s view of the legitimacy of political rights and do other factors also count? The empirical analysis was undertaken done with German youth (N=2244). Findings show that the concept of inherent human dignity is a strong predictor for respondents’ attitudes towards political rights, but that it is not the unique predictor; relevant concepts are the value orientation of youth and their socio-political orientation. The significance of religious beliefs as a predictor is low.     

Gender differences in conversation topics, 1922–1990

Gender differences in conversation topics were first systematically studied in 1922 by Henry Moore, who theorized that the gender differences in topic choice he observed in a field observation study would persist over time, as they were manifestations of men's and women's original natures. In this paper, I report a 1990 replication of Moore's study, in which similar but smaller gender differences in topic choice are found. In order to explore further the apparent trend toward smaller gender differences, reports of quantitative observation studies conducted between 1922 and 1990 are examined. Other explanations besides change over time—such as variations in conversation setting and audience, target populations, and researcher's intentions—may account for the decline in gender differences in topic choice. Social influences are seen more clearly in the discourse about gender differences in conversation than in gender differences in conversation topics themselves.I am grateful to Renee Anspach, Maria Krysan, Howard Schuman, and Candace West for their many helpful suggestions. I also thank the Research Methods students in Howard Schuman's course who, with Maria Krysan, executed the study described in this paper. The Social Sciences and Humanities Research Council of Canada provided support for this project.