Christian Engagement with Public Bioethics in Britain: The Case of Human Admixed Embryos

This paper offers an assessment of the prospects for Christianengagement with public bioethical debates in a contemporaryBritish context. One recent example, the debate provoked byproposed legislation for research involving human admixed embryos,is examined briefly. It is argued that this debate has someproblematic features that are characteristic of public ethicaldebates in this context. Next, a proposal is offered as to howsuch bioethical questions may be approached from within a Christiantheological tradition (specifically, a Reformed Protestant tradition).This proposed approach makes use of four "diagnostic questions"to assess whether technological proposals and practices suchas the creation of human admixed embryos can be consistent withthe distinctive Christian narrative of creation, sin, salvationthrough Christ, and promised future hope. The final sectionoffers some reflections on how Christians and churches mightengage, on the basis of this theological approach, with publicethical debates such as the one about admixed embryos.     

Analogical Reasoning in Handling Emerging Technologies: The Case of Umbilical Cord Blood Biobanking

How are we individually and as a society to handle new and emerging technologies? This challenging question underlies much of the bioethical debates of modern times. To address this question we need suitable conceptions of the new technology and ways of identifying its proper management and regulation. To establish conceptions and to find ways to handle emerging technologies we tend to use analogies extensively. The aim of this article is to investigate the role that analogies play or may play in the processes of understanding and managing new technology. More precisely we aim to unveil the role of analogies as analytical devices in exploring the “being” of the new technology as well the normative function of analogies in conceptualizing the characteristics and applications of new technology. Umbilical cord blood biobanking will be used as a case to investigate these roles and functions.     

Analogical reasoning in handling emerging technologies: the case of umbilical cord blood biobanking

How are we individually and as a society to handle new and emerging technologies? This challenging question underlies much of the bioethical debates of modern times. To address this question we need suitable conceptions of the new technology and ways of identifying its proper management and regulation. To establish conceptions and to find ways to handle emerging technologies we tend to use analogies extensively. The aim of this article is to investigate the role that analogies play or may play in the processes of understanding and managing new technology. More precisely we aim to unveil the role of analogies as analytical devices in exploring the "being" of the new technology as well the normative function of analogies in conceptualizing the characteristics and applications of new technology. Umbilical cord blood biobanking will be used as a case to investigate these roles and functions.     

Prolegomena to any future mereology of the body

Many bioethical arguments rely implicitly on the assumption that the concept of “human part” is one on which everyone must agree, because it is unambiguous. But various parties interpret this “unambiguous” term in incompatible ways, leading to contention. This article is an informal presentation of a topomereological system on whose preferred interpretation several distinct but related meanings of “human part” can be isolated: part of a human body, part of the completion of a human body, and part of a human being. A case is analyzed (the first total artificial heart (TAH) implantation), demonstrating in the process much of the apparatus of the system. By means of a casuistic methodology, the analysis is translated into recommendations for the ethical conduct of future TAH research. The more general conclusion, however, is that formal methods may provide useful tools for clarifying thought processes and organizing arguments in debates over bioethical issues.     

Who/se we are: baptism as personhood.

The attempt to arrive at some consensus on precisely what qualifies a human as a persons represents one of the more persistently debated and widely significant issues in modern biomedical ethics. The attribution of personhood has been and continues to be a powerful tool in moral discourse. Biomedical and bioethical debates about personhood seem especially morally significant in late modernity given the recent trends in biomedical technology. Our attempts to formally articulate universally agreed upon criteria for personhood represent some of the last vestiges of the hope that we can achieve substantial moral agreement in an otherwise morally fragmented world. In this essay, we argue that, from the perspective of certain strands of the Christian tradition, all bioethics grounded in attempts to develop formal, objective criteria by which we may designate a given individual a person are misguided. Criteria centering on the possession of reflective mental capacity, moreover, are for Christians especially problematic. We suggest that there are no morally neutral ways of designating personhood.     

The infant and the infinite: On psychoanalytic faith – Bion,Meltzer and Kierkegaard

This paper discusses the meaning of psychoanalytic faith as a useful developmental concept, which applies to the therapeutic process in the consulting room as to other intimate educational experiences. Faith is a concept which has been little considered in relation to psychoanalysis, partly owing to semantic confusion with ‘the Faith’ as in religious or psychoanalytic dogma, and partly owing to the difficulty of defining or describing what it is, outside accepted jargon. Yet, faith is traditionally the gateway to experiencing the unknown – a psychoanalytic goal-demanding negative capability. It is suggested that philosophy and poetry, where the concept is more familiar, can provide psychoanalytic parallels for this particular type of learning from experience. The viewpoints of Bion, Meltzer and Kierkegaard are taken as contributing to a picture of how, in the psychoanalytic session, there may be a developmental encounter between the infant (patient) and the infinite (the transference process, rather than the analyst as a person).     

AGREEING TO DISAGREE: Indigenous Pluralism from Human Rights to Bioethics

David Hollenbach, working within the context of human rights theory, has developed the notion of "indigenous pluralism" as a means of coping with the problems that arise when different religious traditions hold distinct or incompatible interpretations of human rights. It will be argued that indigenous pluralism is a theoretically and practically useful concept for bioethics as well and hence should be incorporated into bioethical methodology and processes of bioethical policy formation. Subsequently, the notion of indigenous pluralism will be discussed in relation to determinations of death as a means of illustrating this concept's applicability to bioethical inquiry.     

Bioethics in the Making: “Ideal Patients” and the Beginnings of Face Transplant Surgery in Mexico

Medical teams around the world are increasingly gaining ethical clearance to utilise face transplant surgery as a reconstructive surgical procedure. Analysis of the beginnings of the operation in Mexico vis-à-vis the early uptake of the procedure in France reveals that this controversial experimental medical field has become loaded with national significance. The primary issue of dispute has been the dependence on life-threatening immunosuppressant therapy in a procedure that treats otherwise biologically healthy people. Attempts to resolve related debate has resulted in the emergence of what my interlocutors refer to as an “ideal patient”, a person whose particular state of health and suffering render them operable within the current biomedical constraints. Drawing together the idiom of coproduction with the concept of sociotechnical imaginaries shows how this imagined patient category was refracted and stabilised as it entered into the Mexican context whilst producing patients and surgical experts as particular types of bioethical subjects. The flexibility and normative value of the “ideal patient” mobilises and is mobilised by surgeons, who themselves emerge as national bioethical subjects responsible for saving the face of nations in the midst of broader changes surrounding how State's should respond to medical advancement.     

I Want to Hold Your Hand: Abstinence Curricula, Bioethics, and the Silencing of Desire

The abstinence approach to sex education remains influential despite its demonstrated ineffectiveness. One bill forbids the “promotion” of “gateway sexual activity,” while requiring outright condemnation of “non-abstinence,” defined so loosely as to plausibly include handholding. Bioethics seldom (if ever) contributes to sex-ed debates, yet exploring the pivotal role of medical discourse reveals the need for bioethical intervention. Sex-ed debates revolve around a theory of human flourishing based on heteronormative temporality, a developmental teleology ensuring the transmission of various supposed social goods through heterosexual marriage (Halberstam, 2005). Heteronormative temporality also constitutes a moralized discourse in which the values of health and presumed certainties of medicine serve to justify conservative religious dictates that otherwise would appear controversial as the basis for public policy. Overall, this analysis explores how moralized medical discourses compound existing injustices, while suggesting bioethics’ potential contributions to moral and political analysis of sex-ed policies.     

Ethical Obligations and Clinical Goals in End-of-Life Care: Deriving a Quality-of-Life Construct Based on the Islamic Concept of Accountability Before God (Taklīf)

End-of-life medical decision making presents a major challenge to patients and physicians alike. In order to determine whether it is ethically justifiable to forgo medical treatment in such scenarios, clinical data must be interpreted alongside patient values, as well as in light of the physician's ethical commitments. Though much has been written about this ethical issue from religious perspectives (especially Christian and Jewish), little work has been done from an Islamic point of view. To fill the gap in the literature around Islamic bioethical perspectives on the matter, we derive a theologically rooted rubric for goals of care. We use the Islamic obligation for Muslims to seek medical treatment as the foundation for determining the clinical conditions under which Muslim physicians have a duty to treat. We next link the theological concept of accountability before God (taklīf) to quality-of-life assessment. Using this construct, we suggest that a Muslim physician is not obligated to maintain or continue clinical treatment when patients who were formerly of, or had the potential to be, mukallaf (the term for a person who has taklīf), are now not expected to regain that status by means of continued clinical treatment.     

The superordinate self in psychoanalytic theory and in the self psychologies

The concept of the self has been used in several attempts to resolve the epistemological problems of what is subjective and what is objective, what is personal and what is organismic. In addition, it has been used to mediate between the hermeneutic and natural-science approaches to psychoanalytic explanation, between the motivational and causal dimensions of our theory and experience. In the case of Kohut, the self was initially invoked to deal with clinical difficulties associated with the analysis of patients with narcissistic personality disorders more recently, it has become the central article in a "self psychology" that addresses presumed deficiencies in the traditional psychoanalytic picture of psychopathology. But the concept of the self is not suited to be a panacea for resolving theoretical or clinical difficulties. The self as person refers to an entity that is both enduring and changing; it describes continuity in the face of change and change in the face of continuity. Abend (1974) comes closest to capturing this attribute of the self in his image of the tidal beach with a configuration that changes but an essence that remains the same. Eisnitz (1980) evokes something similar in his figure-ground conception of the self-representation. The crux of the matter is that the notion of self-experience includes a variety of phenomena that cannot be contained within a single self-construct--be it normal pathologic, grandiose, or otherwise. As a result of these considerations, I have argued against the use of the self as a superordinate concept in psychoanalytic theory and have focused on the shortcomings of three self psychologies that use the self in this way. I believe that Klein, Gedo, and Kohut all offer the self as a kind of conceptual tranquilizer for the philosophical, theoretical, and clinical dualities that are inherent in psychoanalytic work. Grossman addressed himself to these dualities as far back as 1967 and elaborated on the problems with Simon (1969) in a pathbreaking paper on anthropomorphism in psychoanalysis. Grossman and Simon contended that the controversy about anthropomorphism in psychoanalytic theory pertains to the basic confusion in psychology between meaning and causality. They submitted that until this confusion was dispelled and until some superordinate concept was found that could "encompass both kinds of discourse", attempts to transform psychoanalysis into a general psychology would result in failure.(ABSTRACT TRUNCATED AT 400 WORDS)     

The Porosity of Autonomy: Social and Biological Constitution of the Patient in Biomedicine

The nature and role of the patient in biomedicine comprise issues central to bioethical inquiry. Given its developmental history grounded firmly in a backlash against 20th-century cases of egregious human subjects abuse, contemporary medical bioethics has come to rely on a fundamental assumption: the unit of care (and the unit of value) is the autonomous self-directing patient. In this article we examine first the structure of the feminist social critique of autonomy. Then we show that a parallel argument can be made against relational autonomy as well, demonstrating how this second concept of autonomy fails to take sufficiently into account an array of biological determinants, particularly those from microbial biology. Finally, in light of this biological critique, we question whether or to what extent any relevant and meaningful view of autonomy can be recovered in the contemporary landscape of bioethics.     

Whose Life is it Anyway?

ABSTRACT This paper addresses a current confusion in debates on the morality of experimentation on human pre-embryos: the confusion that arises from ambiguity in the sense of 'human being'. We may quite legitimately decide to apply the term 'human being'to all entities with human DNA but in that case we should not then imply that all human beings are as much objects of moral concern as the fetus or a post-parturate human being. It is argued that whatever classifying terms we use, potential entities need to be distinguished from actual entities and that the very notion of potentiality rests on this distinction. The paper does not offer an argument in favour of experimentation, rather it appeals for clear thought. Moral attitudes to experimentation on pre-embryos are varied and attempts to analyse issues through implicit appeal to emotionally ambiguous terms do not help the moral debate.     

The Latin American contribution to the psychoanalytic concept of phantasy

The author argues that the ubiquity of phantasies at various levels of mental functioning is undisputed in the current schools of psychoanalytic thought; however, she demonstrates some variations in their understanding of how the psychotherapeutic access to different configurations occurs. In the process of examining and acknowledging the central role played by unconscious phantasies in his patients’ symptoms, Freud gradually broadened the vernacular meaning of the German word ‘Phantasie’ that refers to imagination and the world of imagination, conferring on it the specific features that came to characterize its use in the psychoanalytic vocabulary. Later, the expansion of the concept derived from Melanie Klein’s clinical material obtained from child analyses gave rise to important debates. The author discusses the main points of disagreement that led to these debates, as well as their various theoretical and technical implications. Psychoanalytic associations in Latin America were strongly influenced by Klein and her followers. Thus, most of their scientific writings use the concept of unconscious phantasy put forward by the Kleinian school. Taking Kleinian principles as their starting point, Baranger and Baranger made the most original Latin American contribution to the concept of unconscious phantasy with their works on the unconscious phantasies generated by the analytic pair.     

Obedience and Believing a Person

I argue that there is a mutually illuminating parallel between the concept of obedience and the concept of believing a person. Just as both believing what a person says and believing what a person says for the reason that the person says it are insufficient for believing the person, so acting as a person demands and acting as a person demands for the reason that the person demands it are insufficient for obeying the person. Unlike the concept of believing a person, however, the concept of obedience has two distinct senses, one applying to coerced action and one applying to non‐coerced action based on authoritative directives. While the former sense of obedience has no theoretical analogue, the latter sense of obedience can be understood as the practical analogue of the theoretical case of believing a person, making room for a deep parallel between believing and acting on authority.     

Authenticity as a foundational principle of medical ethics

Increasingly, contemporary medical ethicists have become aware of the need to explicate a foundation for their various models of applied ethics. Many of these theories are inspired by the apparent incompatibility of patient autonomy and provider beneficence. The principle of patient autonomy derives its current primacy to a large extent from its legal origins. However, this principle seems at odds with the clinical reality. In the bioethical literature, the notion of authenticity has been proposed as an alternative foundational principle to autonomy. This article examines this proposal in reference to various existentialist philosophers (Heidegger, Sartre, Camus and Marcel). It is concluded that the principle of autonomy fails to do what it is commonly supposed to do: provide a criterion of distinction that can be invoked to settle moral controversies between patients and providers. The existentialist concept of authenticity is more promising in at least one crucial respect: It acknowledges that the essence of human life disappears from sight if life's temporal character is reduced to a series of present decisions and actions. This also implies that the very quest for a criterion that allows physicians to distinguish between sudden, unexpected decisions of their patients to be or not to be respected, without recourse to the patient's past or future, is erroneous.     

Aboriginal Right: A Conciliatory Concept

The confusion that persists over Aboriginal claim in North America calls for close examination. The paper begins by sorting out various versions of 'Aboriginal right'and some of the main factors that govern its use. Confusion is analysed as the result of conflating different frames of reference which determine different sets of expectations by Aboriginal and government representatives.
To appreciate the significance of this conflation, it is helpful if not necessary to view the move to use the concept 'Aboriginal right'as a strategic rather than a legally substantive one. Understanding the move in this way helps to explain why it is that definitions remain elusive. The effect of using the concept has indeed been to enable Aboriginals finally and effectively to table their claim. However, the strategy has its cost. Using the language of the courts places Aboriginal negotiators at a disadvantage, since that language is ineluctably tied to European social and legal sensibilities that militate against understanding Aboriginal claim.
If, in the end, we understand that the move to use the language of the courts has been conciliatory, we can better recognise the nature of Aboriginal claim. We can begin to understand that it involves a complex web of responsibilities and commitments, most of which have either been forgotten or perverted to suit government agendas. We can begin to see that it has to do with restoring a relationship of mutual respect and protection.     

What kinds of alternative possibilities are required of the folk concept(s) of choice?

Our concept of choice is integral to the way we understand others and ourselves, especially when considering ourselves as free and responsible agents. Despite the importance of this concept, there has been little empirical work on it. In this paper we report four experiments that provide evidence for two concepts of choice—namely, a concept of choice that is operative in the phrase having a choice and another that is operative in the phrase making a choice. The experiments indicate that the two concepts of choice can be differentiated from each other on the basis of the kind of alternatives to which each is sensitive. The results indicate that the folk concept of choice is more nuanced than has been assumed. This new, empirically informed understanding of the folk concept of choice has important implications for debates concerning free will, responsibility, and other debates spanning psychology and philosophy.     

Dependence and a Kantian conception of dignity as a value

Kantian moral concepts concerning respect for human dignity have played a central role in articulating ethical guidelines for medical practice and research, and for articulating some central positions within bioethical debates more generally. The most common of these Kantian moral concepts is the obligation to respect the dignity of patients and of human research subjects as autonomous, self-determining individuals. This article describes Kant’s conceptual distinction between dignity and autonomy as values, and draws on the work of several contemporary Kantian philosophers who employ the distinction to make sense of some common moral intuitions, feelings, and norms. Drawing on this work, the article argues that the conceptual distinction between dignity and autonomy as values is indispensable in the context of considering our obligations to those who are dependent and vulnerable.