Psychodynamic group psychotherapy.

The author provides an overview of critical factors in the working phase of group psychotherapy from the perspective of psychodynamic theory. The discussion is organized around a clinical vignette to illustrate various types of intervention such as past, here and now, future; individual, interpersonal, group as a whole; in group--out of group; affect-cognition; and understanding--corrective emotional experience. The critical "windows into the unconscious," transference, counter-transference, and free association, are also discussed in terms of the clinical example. The author concludes his article with a few thoughts about the future of psychodynamic theory in relationship to group treatments.     

Maqasid al-Shariah as a Complementary Framework for Conventional Bioethics: Application in Malaysian Assisted Reproductive Technology (ART) Fatwa

Rapid development in the area of assisted reproductive technology (ART), has benefited mankind by addressing reproductive problems. However, the emergence of new technologies and techniques raises various issues and discussions among physicians and the masses, especially on issues related to bioethics. Apart from solutions provided using conventional bioethics framework, solutions can also be derived via a complementary framework of bioethics based on the Higher Objectives of the Divine Law (Maqasid al-Shariah) in tackling these problems. This approach in the Islamic World has been applied and localised in the Malaysian context. Thus, this paper highlights a conceptual theoretical framework for solving current bioethical issues, with a special focus on ART in the Malaysian context, and compares this theory with conventional theories of bioethics.     

The imperatives of narrative: health interest groups and morality in network news

This article examines some of the story conventions of network television news to explain the ways in which healthcare interest groups develop and maintain their presence in this medium - a process that has significant implications for public understanding of healthcare issues, and therefore to bioethics. The article is divided into three sections. The first section focuses on three major normative conventions of television news: adherence to a simple narrative structure, the balance ethic, and avoidance of the "think-piece" and outlines the basic strategies available to interest groups for exploiting these normative conventions. Section two introduces three case studies of organizations and individuals who have run high-profile media campaigns. Section three explores the implications for bioethics of the observations made in this article.     

Accounting for context: Future directions in bioethics theory and research

Many physicians have found that the traditional approach to bioethics fails to account for important aspects of their moral experience in practice. New approaches to bioethics theory are challenging the traditional application of universal moral principles based in liberal moral theory. At the same time, a shift in both the goals and methods of bioethics education has accompanied its “coming of age” in the medical school curriculum. Taken together, these changes challenge both bioethics educators and theorists to come closer to the details and nuances of real clinical encounters. The emerging trend emphasizes the importance of context in bioethics education and in the moral theory and research under-girding it. This article introduces one research approach examining the practical life contexts of medical students' ethical experiences and learning. It calls for increased attention to research and theory in bioethics that more adequately accounts for the ways different contexts produce significant changes in meaning and understanding in medical encounters.     

Proof of complex theories regarding conflicts, neuroses and their therapy, exemplified by Mjasiscew's theory of relations

Most psycho-dynamic theories emphasize the role of intra-personal conflicts in the aetiology and therapy of neurotic disorders, but very few can be empirically tested. The social psychological and psychodynamic "pathogenetic" theory of the "Leningrad School" of psychotherapy according to Mjasiscew (Lauterbach, 1984) maintains that conflicts between a person's relations with his social, material and cultural environment may be the cause of his neurosis. This theory is used to demonstrate that psychodynamic hypotheses about the role of intra-personal conflicts can be empirically tested with the help of "tests of conflict" (Lauterbach, 1987).     

How philosophy and theology have undermined bioethics.

This essay begins by distinguishing among the viewpoints of philosophy, theology, and religion; it then explores how each deals with "sin" in the bioethical context. The conclusions are that the philosophical and theological viewpoints are intellectually defective in that they cripple our ability to deal with normative issues, and are in the end unable to integrate Christian concepts like "sin" successfully into bioethics. Sin is predicated only of beings with free will, though only in Western Christianity must all sins be committed with knowledge and voluntarily. Without the notions of free will, sin, and a narrative of redemption, bioethics remains unable to provide itself with an adequate normative framework. Bioethics, and morality in general, remain a morass precisely because there has been a failure to translate Christian morality into fully secular and scientistic terms.     

Differences from somewhere: the normativity of whiteness in bioethics in the United States

I argue that there has been inadequate attention to and questioning of the dominance and normativity of whiteness in the cultural construction of bioethics in the United States. Therefore we risk reproducing white privilege and white supremacy in its theory, method, and practices. To make my argument, I define whiteness and trace its broader social and legal history in the United States. I then begin to mark whiteness in U.S. bioethics, recasting Renee Fox's sociological marking of its American-ness as an important initial marking of its whiteness/WASP ethos. Furthermore, I consider the attempts of social scientists to highlight sociocultural diversity as a corrective in U.S. bioethics. I argue that because they fail to problematize white dominance and normativity and the white-other dualism when they describe the standpoints of African-American, Asian-American, and Native-American others, their work merely inoculates difference and creates or maintains minoritized spaces. Accordingly, the dominant white center of mainstream U.S. bioethics must be problematized and displaced for diversity research to make a difference. In conclusion, I give several examples of how we might advance the recommended endeavor of exploring our own ethnicity, class, and other social positioning and norms operating in U.S. bioethics, briefly highlighting "white talk" as one challenge.     

Gert's moral theory and its application to bioethics cases

Bernard Gert's theory of morality has received much critical attention, but there has been relatively little commentary on its practical value for bioethics. An important test of an ethical theory is its ability to yield results that are helpful and plausible when applied to real cases. An examination of Gert's theory and his own attempts to apply it to bioethics cases reveals that there are serious difficulties with regard to its application. These problems are sufficiently severe to support the conclusion that Gert's theory is unacceptable as an approach for resolving bioethics cases, even relatively noncontroversial cases.     

Christian bioethics, secular bioethics, and the claim to cultural authority.

Though the papers in this volume for the most part address the question, "What is Christian about Christian Bioethics", this paper addresses instead a closely related question, "How would a Christian approach to bioethics differ from the kind of secular academic bioethics that has emerged as such an important field in the contemporary university?" While it is generally assumed that a secular bioethics rooted in moral philosophy will be more culturally authoritative than an approach to bioethics grounded in the contingent particularities of a religious tradition, I will give reasons for rejecting this assumption. By examining the history of the recent revival of academic bioethics as well as the state of the contemporary moral philosophy on which it is based I will suggest that secular bioethics suffers from many of the same liabilities as a carefully articulated Christian bioethics. At the end of the paper I will turn briefly to examine the question of how, in light of this discussion, a Christian bioethics might best be pursued.     

On the Christian in Christian bioethics.

What is Christian about Christian bioethics? And is an authentically Christian bioethics a practical possibility in the world in which we find ourselves? In my essay I argue that personhood and the personal are so fundamental to the Christian understanding of our humanity that body, soul, and spirit are probably best understood as the components of a triune (as opposed to dual) aspect theory of personhood. To confess to a Christian bioethics is to admit that Christians cannot pretend fully to understand either cures or their meaning. However effective and "knowledge-based" contemporary medical interventions are, a Christian must humbly and honestly confess a lack of complete knowledge on both levels. At the same time, a Christian bioethicist must express a total personal commitment to Christian Faith.     

A theory of international bioethics: multiculturalism, postmodernism, and the bankruptcy of fundamentalism

The first of two articles analyzing the justifiability of international bioethical codes and of cross-cultural moral judgments reviews "moral fundamentalism," the theory that cross-cultural moral judgments and international bioethical codes are justified by certain "basic" or "fundamental" moral priniciples that are universally accepted in all cultures and eras. Initially propounded by the judges at the 1947 Nuremberg Tribunal, moral fundamentalism has become the received justification of international bioethics, and of cross-temporal and cross-cultural moral judgments. Yet today we are said to live in a multicultural and postmodern world. This article assesses the challenges that multiculturalism and postmodernism pose to fundamentalism and concludes that these challenges render the position philosophically untenable, thereby undermining the received conception of the foundations of international bioethics. The second article, which follows, offers an alternative model -- a model of negotiated moral order -- as a viable justification for international bioethics and for transcultural and transtemporal moral judgments.     

生命伦理学的知识场域与现象学问题

目前,生命伦理学研究中最首要的是,对相关知识、基本概念、语词的统一。应该挖掘所有人类的理性遗产和文化资源,建立和构建生命伦理学理论框架和体系,从而解决对具体生命伦理问题和现象评价的困难。生命伦理学存在一个多维的知识场域,揭示、解释和勾绘这个场域,对生命伦理学的学科建设,具有重要意义。     

A theory of international bioethics: the negotiable and the non-negotiable

The preceding article in this issue of the Kennedy Institute of Ethics Journal presents the argument that "moral fundamentalism," the position that international bioethics rests on "basic" or "fundamental" moral prinicples that are universally accepted in all eras and cultures, collapses under a variety of multicultural and postmodern critiques. The present article looks to the contractarian tradition of Hobbes and Locke -- as reinterpreted by David Gauthier, Robert Nozick, and John Rawls -- for an alternative justification for international bioethics. Drawing on the central themes of this tradition, it is argued that international bioethics can be rationally reconstructed as a negotiated moral order that respects culturally and individually defined areas of nonnegotiability. Further, the theory of a negotiated moral order is consistent with traditional ideals about human rights, is flexible enough to absorb the genuine insights of multiculturalism and postmodernism, and yet is strong enough to justify transcultural and transtemporal moral judgments, including the condemnation of the Nazi doctors at Nuremberg. This theory also is consistent with the history of the ethics of human subjects experimentation and offers insights into current controversies such as the controversy over changing the consent rule for experiments in emergency medicine and the controversy over exempting certain clinical trials of inexpensive treatments for preventing the perinatal transmission of AIDS from the ethical standards of the sponsoring country.     

Creative Group Living in a Children's Institution Edited by Susanne Schulze

Psychoanalytic psychotherapy is not well developed in Japan (Kotani, 1996). Until recently, group psychotherapy in particular has not been well received by patients or clinicians. Cultural difficulties in using group psychotherapy with Japanese patients have now been overcome and a theory of systematic intervention techniques has been developed. The basic dynamic factors of group psychotherapy such as culturally embedded aspects of social and personality structure are analyzed in this article. Culture-bound psychodynamic characteristics of Japanese patients as activated and worked through in the group process are first described with case illustrations. A systemic hypothesis linking cultural and psychodynamic structure is then delineated and the focal points of interventions are explained in terms of the field dynamics of social structure and boundary dynamics of personality structure.     

Respecting difference and moving beyond regulation: tasks for U.S. bioethics commissions in the twenty-first century

This article focuses on two possible missions for a national bioethics commission. The first is handling differences of worldview, political orientation, and discipline. Recent work in political philosophy emphasizes regard for the dignity of difference manifested in "conversation" that seeks understanding rather than agreement. The President's Council on Bioethics gets a mixed review in this area. The second is experimenting with prophetic bioethics. "Prophetic bioethics" is a term coined by Daniel Callahan to describe an alternative to compromise-seeking "regulatory bioethics." It involves a critique of modern medicine. In the contemporary context, the areas of biotechnology and access to health care cry out for prophetic attention. The Council has addressed biotechnology; unfortunately, that experience suggests that the kind of prophecy that it practices poses risks to conversation. With regard to access issues, the article proposes an effort that unites themes of human dignity, solidarity, and limits in support of reform, while highlighting, rather than papering over, differences.     

The problem of gender in family therapy theory

The field of family therapy is now a continuous process like a car cruising on automatic control with the driver comfortably in the lotus position. Family therapy theory rests on normative concepts of the traditional family and idealized conceptions of family relationships. Inequalities in the family associated with gender have been regarded as of little importance to the development of macro theory in the field. The two most influential therapeutic models, psychodynamic and systemic approaches, are each marked by gender bias. The alpha prejudice of psychodynamic theories exaggerates gender differences; the beta prejudice of systemic approaches ignores them. The construction of gender role concepts has led to a false dichotomy, whether supported by traditionalists or feminists. On close examination, gender role ideals turn out to be simplifications and caricatures. The uncritical use of gender role concepts supports power differences between men and women and ignores the complexities and commonalities of human experience. The failure of family therapy theory to deal with gender issues needs to be addressed if a theory that is not just "more of the same" is to be developed.     

What Must We Mean By “Community”? A Processive Account

The term "community" in ethics and bioethics traditionally has been used to designate either a specific kind of moral relationship available to rational agents or, in contrast, the context in which any sense of rational agency can even be understood. I argue that bioethics is better served when both "selves" and "community" are expressed through a more processive language that highlights the functional character of such concepts. In particular, I see the turn to "processive" community in bioethics as a turn towards method, contextualization, and narrative. In clinical practice, such a processive account demands that bioethics concentrate on methods of developing healthy dialogue and deeper understanding from within the problematic situation rather than trying to "fix" problems using ethical tools developed from outside the present situation. "Community," I argue, is in and of the interactive processes of inquiry itself. Such inquiry, such "communitying," requires that we engage individual patients in context; it demands more than simply gaining their permission or mere consent; it demands developing a supportive environment for participation.     

Between morality and repentance: recapturing "sin" for bioethics.

Distinguishing within "sin" the dimensions of anomia, hamartia, and asthenia makes it possible to analyze in greater detail the contrary manners in which traditional and post-traditional Christianities in this issue of Christian Bioethics endeavor to recapture what was lost when secular bioethics reconstructed the specifically spiritual-context-oriented normative commitments of Christianity in one-dimensionally moral terms. Various post-traditional attempts at securing moral orientation and resources for forgiveness, both of which secular bioethics finds increasingly difficult to provide, are critically reviewed. Their engagement of secular moral concepts and concerns, and even their adoption of an academically philosophical posture and language, is presented as responsible for their failure to adequately preserve what in traditional Christianity would count as prohibited vs. permitted, and advisable vs. non-advisable, or what would allow to resolve "tragic conflicts." The deeper reason for this failure lies in post-traditional Christianity's restricting the Christian life (with its central tension between love and the law) to what can be captured by cognitive categories. As the survey of several traditionally Christian accounts of sin in bioethics makes clear, both moral orientation (along with the resolution of "tragic" conflicts) and the sources of forgiveness are available, once that Christian life is framed in terms of persons' spirit-supported practical involvement in ascesis and liturgy, and once bioethical reflections are situated in the experiential context of such involvement.     

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.