Routledge Annals of Bioethics – serie

This book examines the central structures in medicine—medical knowledge, economics, technological innovation, and medical authority—from the perspective of an ethics of care. The author analyzes each of these structures in detail before considering the challenges they present to end of life care. The perspective of an ethics of care allows for a careful focus on how these structures affect the capacity of the health care system to provide the care patients need, on the impact they have on the relationships between patients and care-givers, and on how they affect the care-givers in terms of their own sense of identity and capacity for care. This book offers one of the first focused discussions of an ethics of care across a wide range of social issues and structures in contemporary medicine. It will be of keen interest to advanced students and scholars in bioethics and health care ethics who are interested in these important issues.

This book argues that a conscientiously objecting medical professional should receive an exemption only if the grounds of an objector’s refusal are reasonable. It defends a detailed, contextual account of public reasonability suited for healthcare, which builds from the overarching concept of Rawlsian public reason.The author analyzes the main competing positions and maintains that these other views fail precisely due to their systematic inattention to the grounding reasons behind a conscientious objection; he argues that any such view is plausible to the extent that it mimics the ‘reason-giving requirement’ for conscience objections defended in this work. Only reasonable objections can defeat the prior professional obligation to assign primacy to patient well-being, therefore one who refuses a patient’s request for a legally available, medically indicated, and safe service must be able to explain the grounds of their objection in terms understandable to other citizens within the public institutional structure of medicine. The book further offers a novel policy proposal to deploy the Reasonability View: establishing conscientious objector status in medicine. It concludes that the Reasonability View is a viable and attractive position in this debate.A New Theory of Conscientious Objection in Medicine: Justification and Reasonability will be of interest to researchers and advanced students working in bioethics, medical ethics, and philosophy of medicine, as well as thinkers interested in the intersections between law, medical humanities, and philosophy.

This book offers a novel theory of childhood well-being as a social good. It re-examines our fundamental assumptions about parenting, parental authority, and a liberal society’s role in the raising of children.The author defends the idea that the good of a child is inexorably linked to the good of society. He identifies and critiques the problematic assumption that parenting is an extension of individual liberty and shows how we run into problems in medical decision-making for children because of this assumption. He develops an objective conception of what is good for a child in a liberal society, drawing on the assumptions of liberty, and from here constructs a set of things that society and its members owe children. There are ways in which society should support and intervene in parental decisions to guarantee a child’s well-being. Ultimately, raising children is a social activity that requires input from society. The author then applies this theory of childhood well-being to develop a framework for medical decision-making for children. He also uses practical examples, such as vaccinations, parental leave, and healthcare access, to demonstrate the implications of his theory for public policy.The Limits of Parental Authority: Childhood Wellbeing as a Social Good will be of interest to practitioners, scholars, and advanced students working in bioethics, political philosophy, and public health policy.

This book argues that a conscientiously objecting medical professional should receive an exemption only if the grounds of an objector’s refusal are reasonable. It defends a detailed, contextual account of public reasonability suited for healthcare, which builds from the overarching concept of Rawlsian public reason.The author analyzes the main competing positions and maintains that these other views fail precisely due to their systematic inattention to the grounding reasons behind a conscientious objection; he argues that any such view is plausible to the extent that it mimics the ‘reason-giving requirement’ for conscience objections defended in this work. Only reasonable objections can defeat the prior professional obligation to assign primacy to patient well-being, therefore one who refuses a patient’s request for a legally available, medically indicated, and safe service must be able to explain the grounds of their objection in terms understandable to other citizens within the public institutional structure of medicine. The book further offers a novel policy proposal to deploy the Reasonability View: establishing conscientious objector status in medicine. It concludes that the Reasonability View is a viable and attractive position in this debate.A New Theory of Conscientious Objection in Medicine: Justification and Reasonability will be of interest to researchers and advanced students working in bioethics, medical ethics, and philosophy of medicine, as well as thinkers interested in the intersections between law, medical humanities, and philosophy.

Recent scientific developments, in particular advances in pharmacogenetics and molecular genetics, have given rise to numerous predictive procedures for detecting predispositions to diseases in patients. This knowledge, however, does not necessarily promise benign results for either patients or health care professionals. The aim of this volume is to analyse issues related to prediction and prognosis as a burgeoning field of medicine, which is revolutionizing the way we understand and approach diagnosis and treatment. Combining epistemic and ethical reflection with medical expertise on contemporary practice and research, an interdisciplinary group of international experts critically examine anticipatory medicine from various perspectives, including history of medicine, bioethics, theories of science, and health economics. The highly complex issues involved in medical prediction call for a far-reaching debate on the value and scope of foreknowledge. For example, which responsibilities and burdens arise when still healthy people learn of their predisposition to diseases? How should health care insurance reflect risky life styles? Is the increasing medicalization of life connected with prevention ethically sustainable and financially possible in the developing world? These and other related issues are the subject of this timely and important book, which not only serves as an introduction to the area, but also proposes many feasible solutions to the problems outlined.

Medicine in the twenty-first century is increasingly reliant on research to guarantee the safety and efficacy of medical interventions. As a result, the need to understand the ethical issues that research generates is becoming essential. This volume introduces the principal areas of concern in research on human subjects, offering a framework for understanding research ethics, and the relationship between ethics and compliance.Research Ethics brings together leading scholars in bioethics and the topics covered include the unique concerns that arise in specific areas of research such as gene therapy and stem cell research. Individual chapters also address the ethical issues that occur when conducting research with specific populations such as infants or adolescents, and the volume looks at important emerging questions in human subjects research, namely financial conflicts of interest and the interpretation of scientific data.

Our understanding of gender carries significant bioethical implications. An errant account of gender-specific disease can lead to overgeneralizations, undergeneralizations, and misdiagnoses. It can also lead to problems in the structure of health-care delivery, the creation of policy, and the development of clinical curricula. In this volume, Cutter argues that gender-specific disease and related bioethical discourses are philosophically integrative. Gender-specific disease is integrative because the descriptive roles of gender, disease, and their relation are inextricably tied to their prescriptive roles within frames of reference. An integrative account of gender-specific disease carries ethical implications because our understanding of gender-specific disease is evaluative, and our evaluations of gender-specific disease entail judgments concerning the praiseworthiness and blameworthiness of a clinical event. Cutter supports a "both/and" emphasis on context and integration in relation to gender-specific disease and bioethical analyses. While the text mainly focuses on gender-specific diseases that affect women, Cutter also includes examples involving men, children, and members of the LGBT community.

Death, Posthumous Harm, and Bioethics offers a highly distinctive and original approach to the metaphysics of death and applies this approach to contemporary debates in bioethics that address end-of-life and post-mortem issues. Taylor defends the controversial Epicurean view that death is not a harm to the person who dies and the neo-Epicurean thesis that persons cannot be affected by events that occur after their deaths, and hence that posthumous harms (and benefits) are impossible. He then extends this argument by asserting that the dead cannot be wronged, finally presenting a defence of revisionary views concerning posthumous organ procurement.

First published in 2004. Religious Perspectives in Bioethics surveys recent bioethics discussion in thirteen religious traditions. Christian contributions include chapters on Roman Catholicism, Orthodox Christianity, the Episcopal, German Protestant, and Baptist traditions, Reformed Christianity, and the Latter Day Saints. The volume also includes chapters on Judaism, Islam, Hinduism, Buddhism, Sikhism, and Daoism.

Issues in bioethics often turn, at least in part, on the law and regulatory requirements. Consisting of chapters that address particular bioethics topics from the law’s perspective, this fascinating book includes:an introduction to the American legal systempapers identifying the principal ways in which the law influences discussions and decisions concerning each of the topics highlightedsupplemental papers on certain areas that address the influence and status of the law in countries other than the United States.Covering traditional topics in bioethics, such as determinations of death and health care decisions for vulnerable groups, this study also explores emerging areas such as conflicts of interest in research, genetics, and privacy and confidentiality in the electronic age.Incisive and thought-provoking, this volume provides readers with a rich context for understanding the intersection between the law on bioethics and the central issues in bioethics.

Alongside a revival of interest in Thomism in philosophy, scholars have realised its relevance when addressing certain contemporary issues in bioethics. This book offers a rigorous interpretation of Aquinas's metaphysics and ethical thought, and highlights its significance to questions in bioethics. Jason T. Eberl applies Aquinas’s views on the seminal topics of human nature and morality to key questions in bioethics at the margins of human life – questions which are currently contested in the academia, politics and the media such as: When does a human person’s life begin? How should we define and clinically determine a person’s death? Is abortion ever morally permissible? How should we resolve the conflict between the potential benefits of embryonic stem cell research and the lives of human embryos? Does cloning involve a misuse of human ingenuity and technology? What forms of treatment are appropriate for irreversibly comatose patients? How should we care for patients who experience unbearable suffering as they approach the end of life? Thomistic Principles and Bioethics presents a significant philosophical viewpoint which will motivate further dialogue amongst religious and secular arenas of inquiry concerning such complex issues of both individual and public concern.

Human Dignity in Bioethics brings together a collection of essays that rigorously examine the concept of human dignity from its metaphysical foundations to its polemical deployment in bioethical controversies. The volume falls into three parts, beginning with meta-level perspectives and moving to concrete applications. Part 1 analyzes human dignity through a worldview lens, exploring the source and meaning of human dignity from naturalist, postmodernist, Protestant, and Catholic vantages, respectively, letting each side explain and defend its own conception. Part 2 moves from metaphysical moorings to key areas of macro-level influence: international politics, American law, and biological science. These chapters examine the legitimacy of the concept of dignity in documents by international political bodies, the role of dignity in American jurisprudence, and the implications—and challenges—for dignity posed by Darwinism. Part 3 shifts from macro-level topics to concrete applications by examining the rhetoric of human dignity in specific controversies: embryonic stem cell research, abortion, human-animal chimeras, euthanasia and palliative care, psychotropic drugs, and assisted reproductive technologies. Each chapter analyzes the rhetorical use of ‘human dignity’ by opposing camps, assessing the utility of the concept and whether a different concept or approach can be a more productive means of framing or guiding the debate.

Issues in bioethics often turn, at least in part, on the law and regulatory requirements. Consisting of chapters that address particular bioethics topics from the law’s perspective, this fascinating book includes:an introduction to the American legal systempapers identifying the principal ways in which the law influences discussions and decisions concerning each of the topics highlightedsupplemental papers on certain areas that address the influence and status of the law in countries other than the United States.Covering traditional topics in bioethics, such as determinations of death and health care decisions for vulnerable groups, this study also explores emerging areas such as conflicts of interest in research, genetics, and privacy and confidentiality in the electronic age.Incisive and thought-provoking, this volume provides readers with a rich context for understanding the intersection between the law on bioethics and the central issues in bioethics.

Medicine in the twenty-first century is increasingly reliant on research to guarantee the safety and efficacy of medical interventions. As a result, the need to understand the ethical issues that research generates is becoming essential. This volume introduces the principal areas of concern in research on human subjects, offering a framework for understanding research ethics, and the relationship between ethics and compliance.Research Ethics brings together leading scholars in bioethics and the topics covered include the unique concerns that arise in specific areas of research such as gene therapy and stem cell research. Individual chapters also address the ethical issues that occur when conducting research with specific populations such as infants or adolescents, and the volume looks at important emerging questions in human subjects research, namely financial conflicts of interest and the interpretation of scientific data.

This book examines the question of what parental obligations procreators incur by bringing children into being. Prusak argues that parents, as procreators, have obligations regarding future children that constrain the liberty of would-be parents to do as they wish. Moreover, these obligations go beyond simply respecting a child’s rights. He addresses in turn the ethics of adoption, child support, gamete donation, surrogacy, prenatal genetic enhancement, and public responsibility for children.

In this book, public health ethicist Daniel S. Goldberg sets out to characterize the subjective experience of pain and its undertreatment within the US medical establishment, and puts forward public policy recommendations for ameliorating the undertreatment of pain. The book begins from the position that the overwhelming focus on opioid analgesics as a means for improving the undertreatment of pain is flawed, and argues instead that dominant Western models of biomedicine and objectivity delegitimize subjective knowledge of the body and pain in the US. This general intolerance for the subjectivity of pain is part of a specific American culture of pain in which a variety of actors take part, including not only physicians and health care providers, but also pain sufferers, caregivers, and policymakers. Concentrating primarily on bioethics, history, and public policy, the book brings a truly interdisciplinary approach to an urgent practical ethical problem. Taking up the practical challenge, the book culminates in a series of policy recommendations that provide pathways for moral agents to move beyond contests over drug policy to policy arenas that, based on the evidence, hold more promise in their capacity to address the devastating and inequitable undertreatment of pain in the US.

Human genetic engineering may soon be possible. The gathering debate about this prospect already threatens to become mired in irresolvable disagreement. After surveying the scientific and technological developments that have brought us to this pass, The Ethics of Genetic Engineering focuses on the ethical and policy debate, noting the deep divide that separates proponents and opponents. The book locates the source of this divide in differing framing assumptions: reductionist pluralist on one side, holist communitarian on the other. The book argues that we must bridge this divide, drawing on the resources from both encampments, if we are to understand and cope with the distinctive problems posed by genetic engineering. These problems, termed "fractious problems," are novel, complex, ethically fraught, unavoidably of public concern, and unavoidably divisive. Berry examines three prominent ethical and political theories – utilitarianism, Kantianism, and virtue ethics – to consider their competency in bridging the divide and addressing these fractious problems.The book concludes that virtue ethics can best guide parental decision making and that a new policymaking approach sketched here, a "navigational approach," can best guide policymaking. These approaches enable us to gain a rich understanding of the problems posed and to craft resolutions adequate to their challenges.

Alongside a revival of interest in Thomism in philosophy, scholars have realised its relevance when addressing certain contemporary issues in bioethics. This book offers a rigorous interpretation of Aquinas's metaphysics and ethical thought, and highlights its significance to questions in bioethics. Jason T. Eberl applies Aquinas’s views on the seminal topics of human nature and morality to key questions in bioethics at the margins of human life – questions which are currently contested in the academia, politics and the media such as: When does a human person’s life begin? How should we define and clinically determine a person’s death? Is abortion ever morally permissible? How should we resolve the conflict between the potential benefits of embryonic stem cell research and the lives of human embryos? Does cloning involve a misuse of human ingenuity and technology? What forms of treatment are appropriate for irreversibly comatose patients? How should we care for patients who experience unbearable suffering as they approach the end of life? Thomistic Principles and Bioethics presents a significant philosophical viewpoint which will motivate further dialogue amongst religious and secular arenas of inquiry concerning such complex issues of both individual and public concern.

What is the relationship between scientific research and ethics? Some think that science should be free from ethical and political considerations. Biomedical Research and Beyond argues that ethical guidance is essential for all forms of inquiry, including biomedical and scientific research. By addressing some of the most controversial questions of biomedical research, such as embryonic research, animal research, and genetic enhancement research, the author argues for a rich moral framework for the ethics of inquiry, based on the ideal of human flourishing. He then looks at other areas of inquiry, such as journalistic ethics, and military investigation, to see how similar they are to the ethics of scientific research. Finally, he looks at the virtues that must play a role in any life that is devoted to research and inquiry as a vocational commitment.

Human genetic engineering may soon be possible. The gathering debate about this prospect already threatens to become mired in irresolvable disagreement. After surveying the scientific and technological developments that have brought us to this pass, The Ethics of Genetic Engineering focuses on the ethical and policy debate, noting the deep divide that separates proponents and opponents. The book locates the source of this divide in differing framing assumptions: reductionist pluralist on one side, holist communitarian on the other. The book argues that we must bridge this divide, drawing on the resources from both encampments, if we are to understand and cope with the distinctive problems posed by genetic engineering. These problems, termed "fractious problems," are novel, complex, ethically fraught, unavoidably of public concern, and unavoidably divisive. Berry examines three prominent ethical and political theories – utilitarianism, Kantianism, and virtue ethics – to consider their competency in bridging the divide and addressing these fractious problems.The book concludes that virtue ethics can best guide parental decision making and that a new policymaking approach sketched here, a "navigational approach," can best guide policymaking. These approaches enable us to gain a rich understanding of the problems posed and to craft resolutions adequate to their challenges.

This is the first volume in which an account of personal autonomy is developed that both captures the contours of this concept as it is used in social philosophy and bioethics, and is theoretically grounded in, and a part of, contemporary autonomy theory. James Stacey Taylor’s account is unique as it is explicitly a political one, recognizing that the attribution of autonomy to agents is dependent in part on their relationships with others and not merely upon their own mental states. The volume is distinctive in its examples, which touch on the ethics of using inducements to encourage persons to participate in medical research, the ethical issues associated with the use of antibiotics, and the ethical basis for both patient confidentiality and informed consent.

Bioethics, Public Moral Argument, and Social Responsibility explores the role of democratically oriented argument in promoting public understanding and discussion of the benefits and burdens of biotechnological progress.The contributors examine moral and policy controversies surrounding biomedical technologies and their place in American society, beginning with an examination of discourse and moral authority in democracy, and addressing a set of issues that include: dignity in health care; the social responsibilities of scientists, journalists, and scholars; and the language of genetics and moral responsibility.

What is the relationship between scientific research and ethics? Some think that science should be free from ethical and political considerations. Biomedical Research and Beyond argues that ethical guidance is essential for all forms of inquiry, including biomedical and scientific research. By addressing some of the most controversial questions of biomedical research, such as embryonic research, animal research, and genetic enhancement research, the author argues for a rich moral framework for the ethics of inquiry, based on the ideal of human flourishing. He then looks at other areas of inquiry, such as journalistic ethics, and military investigation, to see how similar they are to the ethics of scientific research. Finally, he looks at the virtues that must play a role in any life that is devoted to research and inquiry as a vocational commitment.

This is the first volume in which an account of personal autonomy is developed that both captures the contours of this concept as it is used in social philosophy and bioethics, and is theoretically grounded in, and a part of, contemporary autonomy theory. James Stacey Taylor’s account is unique as it is explicitly a political one, recognizing that the attribution of autonomy to agents is dependent in part on their relationships with others and not merely upon their own mental states. The volume is distinctive in its examples, which touch on the ethics of using inducements to encourage persons to participate in medical research, the ethical issues associated with the use of antibiotics, and the ethical basis for both patient confidentiality and informed consent.

The Ethics of Pregnancy, Abortion and Childbirth addresses the unique moral questions raised by pregnancy and its intimate bodily nature. From assisted reproduction to abortion and ‘vital conflict’ resolution to more everyday concerns of the pregnant woman, this book argues for pregnancy as a close human relationship with the woman as guardian or custodian. Four approaches to pregnancy are explored: ‘uni-personal’, ‘neighborly’, ‘maternal’ and ‘spousal’. The author challenges not only the view that there is only one moral subject to consider in pregnancy, but also the idea that the location of the fetus lacks all inherent, unique significance. It is argued that the pregnant woman is not a mere ‘neighbor’ or helpful stranger to the fetus but is rather already in a real familial relationship bringing real familial rights and obligations. If the status of the fetus is conclusive for at least some moral questions raised by pregnancy, so too are facts about its bodily relationship with, and presence in, the woman who supports it. This lucid, accessible and original book explores fundamental ethical issues in a rich and often neglected area of philosophy in ways of interest also to those from other disciplines.

In this book, public health ethicist Daniel S. Goldberg sets out to characterize the subjective experience of pain and its undertreatment within the US medical establishment, and puts forward public policy recommendations for ameliorating the undertreatment of pain. The book begins from the position that the overwhelming focus on opioid analgesics as a means for improving the undertreatment of pain is flawed, and argues instead that dominant Western models of biomedicine and objectivity delegitimize subjective knowledge of the body and pain in the US. This general intolerance for the subjectivity of pain is part of a specific American culture of pain in which a variety of actors take part, including not only physicians and health care providers, but also pain sufferers, caregivers, and policymakers. Concentrating primarily on bioethics, history, and public policy, the book brings a truly interdisciplinary approach to an urgent practical ethical problem. Taking up the practical challenge, the book culminates in a series of policy recommendations that provide pathways for moral agents to move beyond contests over drug policy to policy arenas that, based on the evidence, hold more promise in their capacity to address the devastating and inequitable undertreatment of pain in the US.

Bioethics is a field of inquiry and as such is fundamentally an epistemic discipline. Knowing how we make moral judgments can bring into relief why certain arguments on various bioethical issues appear plausible to one side and obviously false to the other. Uncertain Bioethics makes a significant and distinctive contribution to the bioethics literature by culling the insights from contemporary moral psychology to highlight the epistemic pitfalls and distorting influences on our apprehension of value. Stephen Napier also incorporates research from epistemology addressing pragmatic encroachment and the significance of peer disagreement to justify what he refers to as epistemic diffidence when one is considering harming or killing human beings. Napier extends these developments to the traditional bioethical notion of dignity and argues that beliefs subject to epistemic diffidence should not be acted upon. He proceeds to apply this framework to traditional and developing issues in bioethics including abortion, stem cell research, euthanasia, decision-making for patients in a minimally conscious state, and risky research on competent human subjects.

Perinatal hospice is a novel form of care for an unborn child who has been diagnosed with a significantly life-limiting condition. In this book, Aaron D. Cobb develops a virtue-based defense of the value of perinatal hospice. He characterizes its promotion and provision as a common project of individuals, local communities, and institutions working together to provide exemplary care. Engaging with important themes from the work of Alasdair MacIntyre and Robert Adams, he shows how perinatal hospice manifests virtues crucial to meeting the needs of families in these difficult circumstances. As a work of applied virtue ethics, this book has important normative, social, and political implications for the creation and development of structured programs of care. It grounds the view that communities ought (i) to devote resources to ensure that these programs are widely available and (ii) to develop social structures that promote awareness of and accessibility to these forms of care. A Virtue-Based Defense of Perinatal Hospice will be of interest to philosophers working in bioethics and applied virtue ethics, as well as scholars in the fields of neonatology, nursing, palliative and hospice care, and counseling who are interested in the study of perinatal hospice.

This book provides extensive and critical engagement with some of the most recent and compelling arguments favoring abortion choice. It features original essays from leading and emerging philosophers, bioethicists and medical professionals that present philosophically sophisticated and novel arguments against abortion choice.The chapters in this book are divided into three thematic sections. The first set of essays focuses primarily on unborn human individuals—zygotes, embryos and fetuses. In these chapters, it is argued, for example, that human organisms begin to exist at conception and that zygotes, embryos and fetuses are persons. These chapters also explore questions about whether or not zygotes, embryos and fetuses are part of their mothers’ bodies. The second set of essays focuses primarily on elective abortion and the debates surrounding it. These chapters consider whether or not opponents of abortion are commonly hypocritical, how opponents of abortion should think about adoption, how emerging technologies may affect the current debate and whether or not those participating in the debate should rely on analogies to support their case. Finally, the third set of essays shifts focus from the legal and moral status of elective abortion to its place in medical practice. In these chapters, it is argued that elective abortion embodies a kind of ableism, that elective abortion is medically unnecessary, harmful to women’s mental health and that telemedicine abortion poses significant risks to women’s health.Agency, Pregnancy and Persons offers an up-to-date examination of unborn human beings, the debates surrounding elective abortion and the place of elective abortion within medical practice. It will be of interest to medical professionals and those who work in philosophy, bioethics and medical ethics alike.