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Table of Contents
Table of Contents
ASLME - [PDF] (Free Download)
Table of Contents
Symposium Articles
Looking Forward in Bioethics
Jeffrey Kahn, Anna Mastroianni - [PDF]

Looking Forward in Bioethics
Bioethics and the National Security State
Jonathan D. Moreno - [PDF]

In previous work I have described thehistory and ethics of human experimentsfor national security purposes during thecold war and developed the bioethicalissues that will be apparent in the "war onterror." This paper is an attempt to bringthese two previous lines of work togetherunder the rubric of the "national securitystate," a concept familiar to Cold Warhistorians and political scientists. Thefounding of the national security state wasassociated with the first articulations ofinformed consent requirements bynational security agencies. My analysisindicates that strengthened consentstandards, though conventionally thoughtto be antithetical to state interests duringan international crisis, can be seen as anattempt by the postwar national securitystate to protect itself from critics ofexpanded governmental power. During thecoming years the renewed mission of thenational security state in the war on terrorshould impel students of bioethics toconsider its implications for futurediscourse in the field.
Does Ethical Theory Have a Future in Bioethics?
Tom L. Beauchamp - [PDF]

Although there has long been a successful andstable marriage between philosophical ethi-cal theory and bioethics, the marriage hasbecome shaky as bioethics has become a moreinterdisciplinary and practical field. A prac-tical price is paid for theoretical generality inphilosophy. It is often unclear whether and,if so, how theory is to be brought to bear ondilemmatic problems, public policy, moralcontroversies, and moral conflict.Threeclearly philosophical problems are used to seehow philosophers are doing in handlingpractical problems: Cultural Relativity andMoral Universality, Moral Justification, andConceptual Analysis. In each case it isargued that philosophers need to developtheories and methods more closely attunedto practice.The work of philosophers such asRuth Macklin, Norman Daniels, and GeraldDworkin is examined.In the writings of eachthere is a major methological gap betweenphilosophical theory (or method) andpractical con-clusions.The future of philo-sophical ethics in interdisciplinary bioethicsmay turn on whether such gaps can beclosed. If not, bioethics may justifiablyconclude that philosophy is of little value.
Clinical Ethics and the Road Less Taken: Mapping the Future by Tracking the Past
Susan B. Rubin, Laurie Zoloth - [PDF]

Although various aspects of clinical ethicsconsultation have been discussed in theliterature, there has yet to be sustainedsystematic debate about the fundamentalphilosophical and methodological issues atstake in doing clinical ethics. Arguing thatthe field of clinical ethics is at a criticalcrossroads, the authors of this articleoutline the core issues that need to beaddressed, debated, and resolved in order for the field to secure a meaningful future.
The Future of Empirical Research in Bioethics
Jeremy Sugarman - [PDF]

Good empirical research is essential toproviding sound answers about the factsof the matter, thereby informing bioethicaltheory and policy. Nevertheless, relativelyfew topics have been addressed adequatelyand the most powerful methods have notbeen exploited to maximize the potentialcontribution of this work to the field.
Public Health Ethics: From Foundations and Frameworks to Justice and Global Public Health
Nancy E. Kass - [PDF]

Ethics dilemmas have been present through-out the history of public health, and bioet-hics has devoted considerable attention toissues relevant to public health. Only re-cently, however, has public health ethicsemerged as a recognized subfield of bio-ethics. Public health ethics requires thatpublic health improvement come throughjust and respectful means. Bioethics in thefuture not only will take on more issues ofpublic health ethics, but will apply itsextensive scholarship in distributive justiceto questions of global public health.
New Malaise: Bioethics and Human Rights in the Global Era
Paul Farmer, Nicole Gastineau Campos - [PDF]

Recent transnational HIV research projects have raised questions about the ethics ofresearch in developing countries, and with good reason. Lower ethical standards areoften applied in these settings, yet the fieldof bioethics has remained relatively quieton the subject, concerning itself primarily with issues that only affect affluent countries. Here we call for a new focus on equity and human rights in bioethics.
Accounting for Culturein a Globalized Bioethics
Patricia Marshall, Barbara Koenig - [PDF]

How might a global bioethics account forprofound cultural difference in a worldmarked by porous borders? The authorsendorse a critical, self-reflexive bioethics,suggesting that bioethics needs to change itsfundamental orientation if it is going toremain relevant and intellectually vibrantthroughout the twenty-first century. Bioethicsmust attend to issues of social justice andpublic health, while seriously considering theimplications of social context for medicalmorality. Negotiating moral consensusacross cultural boundaries will be difficult,but it is more likely to succeed if we criticallyengage with the cultural assumptionsunderlying bioethics itself.
FACE Facts: Why Human Genetics Will Always Provoke Bioethics
Eric T. Juengst - [PDF]

Some people dispute the relative importance of issues in genetics and biotechnology forthe future of bioethics, either because they think the problems are time-limited orbecause they give priority to issues of human rights and social justice in health care. Infact, the special historical standing ofgenetics issues in bioethics reflects four over-lapping sources of moral sensitivity whichare inherent in the stories that geneticscience tells and raise paradigmatic justiceconcerns: the implications of new geneticknowledge for people's understanding oftheir familial roles, ancestral origins,community memberships, and ethnicaffiliations. Beneath worries over "geneticprivacy," "the therapeutic gap," and the "post-human," this constellation of basichuman rights concerns is emerging as thewellspring which both insures and justifiesa central place for genetics on the agendaof bioethics.
Bioethics: A Field in Transition
Ruth R. Faden - [PDF]

Bioethics is clearly a field in transition, ifnot confusion. The author examines twoquestions at the core of this transition. First, how will bioethics accommodate thedifferent training needs and professionalinterests of those who understand them-selves to be primarily scholars of bioethics,and those who understand themselves tobe primarily practitioners of bioethics? Andsecond, whether bioethics will continue tofunction as an interdisciplinary field orwhether it will morph into a discipline inits own right.
How Can We Help? From "Sociology in" to "Sociology of" Bioethics
Raymond De Vries - [PDF]

Sociology and bioethics have an uneasyrelationship. Bioethicists find sociologyhelpful for describing and analyzingethical issues, but they are less enthusiasticwhen bioethics becomes the subject ofsociological scrutiny. After review of differ-ent sociological approaches to bioethicaltopics - descriptive, evaluative, andanalytical - I explain how bioethics willbenefit by using the tools of sociology toanswer its questions ("sociology in bioethics")and by allowing sociology to use bioethicsto answer sociological questions ("sociologyof bioethics").
Law & Bioethics: From Values to Violence
Susan M. Wolf - [PDF]

The relationship of law to bioethics, alwayscomplex, has shifted post-9/11.Instead oflooking to law as protector of rights andliberties, the new bioethics approach,exemplified by the President's Council onBioethics, deploys law as aggressor. Thuswe see a call to get tough, to prohibit a rangeof biomedical practices, with the prospectof not only civil but criminal enforcement.Bioethicists face a grave choice, whetherto embrace the use of state force to resolvebioethics debates.
Passing on the Right: Conservative Bioethics is Closer Than It Appears
R. Alta Charo - [PDF]

Like automobiles in the passenger sidemirror, conservative bioethics is closer thanit appears, and it has joined forces with theneo-conservative movement's rejection ofmoral relativism and moral pluralism. LeonKass and about half of the current bioethicscouncil appointed by President Bush forman interlocking world of journals, confer-ences, presidential advisors and, mostnotably, bioethics commission staff, allworking to promote and extend federalregulation of public morals in the name of preserving real and romanticized societalnorms in the face of social evolution wroughtby technological change.
Independent Articles
Pain, Impairment, and Disability in the AMA Guides
James P. Robinson, Dennis C. Turk, John D. Loeser - [PDF]

Physicians use the American MedicalAssociation's Guides to the Evaluation ofPermanent Impairment, 5th edition toevaluate millions of disability applicantseach year. As major contributors to thechapter in the Guides devoted to assessingimpairment associated with pain, weconfronted the difficulties of incorporatingpain into the Guides' overall evaluationsystem. Analysis of these difficulties iscomplicated by the paucity of research onthe Guides, and by ambiguities andcontradictions that pervade it. We proposethat the ambiguities can be reduced ifimpairment is consistently defined in termsof organ or body part derangement, anddisability in terms of activity limitations atthe level of the whole person. We alsopropose a distinction between objectivefactors and subjective factors that mayinfluence a person's ability to performactivities following injury. We suggest thatwhen physicians examine disability appli-cants, they should evaluate both objectivemeasures of organ or body part dysfunc-tion and subjective reports of applicants -especially ones regarding pain. We conclude that a comprehensive medicalevaluation of a disability applicant encompasses more than an impairment assessment.
Toward Rational Criminal HIV Exposure Laws
Carol L. Galletly, Steven D. Pinkerton - [PDF]

This article examines criminal HIVexposure statutes that address undisclosedexposure through consensual sexualactivity. Twenty-seven U.S. states haveadopted some form of HIV exposurestatute. Thirteen of these statutes specifi-cally address exposure through sexualactivity, while another eleven statutes couldbe applied to exposure through consensualsexual interactions. Although the penal-ties for breach of these laws are oftensevere, the risk of actual harm posed by themany of the behaviors proscribed isminimal and in some cases virtually non-existent. After an overview of the varioustypes of U.S. criminal HIV exposure statutes and a discussion of the risk of HIVtransmission through the various sexualactivities addressed in the laws, the authorshighlight the tenuous relationship betweenproscribed activities and actual risk ofvirus transmission. The authors addressthis limitation in the law by offering aframework for the evaluation andconstruction of HIV exposure statutes thatconsiders not only the intent of the HIV-positive actor but also the risk that his orher conduct poses to others.
Making Risk-Benefit Assessments of Medical Research Protocols
Alex Rajczi - [PDF]

It is commonly assumed that medicalexperiments are ethical only if they havefavorable 'risk-benefit ratios'. In this paperit is argued that 'risk-benefit ratios' oftencannot be calculated, even roughly; andthat even if they could, ethical experimentsdon't need to have favorable 'risk-benefitratios'. In addition, a new method ofassessing an experiment's risks andbenefits is proposed-a method grounded inthe principles of liberal government.
Medication Errors in Family Practice,in Hospitals and After Discharge from the Hospital: An Ethical Analysis
Peter A. Clark - [PDF]

Thousands of medical errors are occurringdaily in physician's offices, in hospitals,and even upon discharge from the hospital, leading to unnecessary injury and deathand costing billions of dollars. We have asystems approach that has been proven tobe tried and true in aviation, nuclearenergy and many other industrial settings.Being honest when medical mistakesoccur, reporting them to a national clear-ing house, objectively searching for rootcauses, avoiding the fixing of arbitraryblame, and then, where possible, implement-ing safeguards to minimize the occurrenceof future mistakes, is the best way to enhancepatient safety. But until the medical estab-lishment takes medical errors and patientsafety more seriously, and until the generalpublic rises up in protest, it is up to the stateand federal governments to take the lead inprotecting the lives of innocent Americansby creating a public policy.
Error Reduction, Patient Safety and Institutional Ethics Committees
Mark E. Meaney - [PDF]

Institutional ethics committees remainlargely absent from the literature on errorreduction and patient safety. In this paper,the author endeavors to fill the gap. Asnoted in the Hastings Center's recentreport, "Promoting Patient Safety," theoccurrence of medical error involves acomplex web of multiple factors. Humanmisstep is certainly one such factor, but notthe only one. This paper builds on theHasting Center's report in arguing thatinstitutional ethics committees ought to playan integral role in the transformation of a"culture of blame" to a "culture of safety" in healthcare delivery.
Recent Developments in Health Law
American Journal of Law & Medicine, Harvard Law & Health Care Society - [PDF]

Recent Developments in Health Law
Currents in Contemporary Ethics
Timothy Caulfield, Trudo Lemmens,Douglas Kinsella, Michael McDonald - [PDF]

Currents in Contemporary Ethics