Bioethics is clearly a field in transition, if not confusion. Bioethics began as a scholarly, reflective, academic enterprise. Increasingly, however, some in bioethics are not as interested in producing scholarship as they are in practicing bioethics by providing services to institutions and clients.Bioethics also began as an interdisciplinary line of inquiry, with its major contributors all trained in some established discipline. We were and for the most part still are a field composed of theologians, philosophers, lawyers, physicians, nurses, and social (...) scientists who work in bioethics. Today, however, some young people actually aspire to be bioethicists. Increasingly, they have the option of being trained directly in bioethics, without any other disciplinary background.We are not the first field to find itself engaged in these kinds of transitions. In this short piece, I consider very briefly how two fields--health psychology and epidemiology- have approached similar branch points. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Informed Consent and Clinical ResearchRuth Faden (bio)Informed consent is a powerful symbol of the commitment and impact of the new, interdisciplinary field of biomedical ethics that the Kennedy Institute has been so instrumental in developing. In the early years of biomedical ethics, there was considerable discussion about the nature of the doctor-patient relationship, about how it ought to be structured, and about how competing values within that relationship (...) ought to be accommodated. By the 1970s and 1980s, the answer was for all practical purposes in. Biomedical ethics was engaged in a clearly reformist project, in step with the values of the times, to right a wrongful imbalance of power and control between physicians and patients.The agenda was clear—to establish the moral authority of the patient to participate in medical decision making by placing respect for the autonomy of patients on the moral map of the medical community. The chief strategy that biomedical ethics adopted to accomplish this agenda was, of course, informed consent. Theories of autonomous action as well as informed consent were intentionally crafted to advance this reformist agenda.In this paper, I examine how the theory of informed consent has fared in one particular realm of “the clinic” where, arguably, there has been considerable success. This is the realm of clinical research; research at the bedside where the patient is also the subject.I rely heavily on the work of President Clinton’s Advisory Committee on Human Radiation Experiments, which I chaired. The Advisory Committee was established in response to exposés in the press about alleged secret experiments during World War II and the Cold War in which patients had been injected with plutonium without their apparent knowledge or consent. As part of its work, the Advisory Committee undertook an oral history project in which we interviewed eminent physicians about the norms and practices of human research in the 1940s and 1950s.Drawing on these interviews, I argue here for two seemingly inconsistent conclusions. First, that the ethical standards for clinical research have changed dramatically in the last 50 years—particularly with respect to informed consent. Second, that despite these important changes, the human dynamics of clinical research in many respects remain unchanged.How the World of Clinical Research Has ChangedDuring the forties and fifties, duties to obtain informed consent, whether for treatment or for research, were simply not part of the doctor-patient experience. [End Page 356]As one physician told us:In 1945, ‘50, the doctor... was king or queen. It never occurred to a doctor to ask for consent for anything. Doctors weren’t in the habit of telling the patients anything (either). They were in charge and nobody questioned their authority.(Advisory Committee on Human Radiation Experiments 1996, p. 83)This unquestioned authority extended to all decisions about the management of the patient, including whether patients were to receive experimental therapies or otherwise become the subjects of research or experimentation. Physicians were trained to be concerned with risk, and harm, and benefit, in keeping with the Hippocratic tradition. But in most institutions, the permission to try something new and to take unknown risks came, not from the patient, but from the chairman of the department.In part, this broad license reflected the very newness of scientifically grounded medical practice. In the forties and fifties, many potentially therapeutic interventions were newly discovered and in this sense considered experimental, or at least innovative. The level of uncertainty about whether a treatment would work was generally high, whether the treatment was part of a research project or not. Moreover, the formalizing of medical science at the bedside was itself still in its infancy—it was not until 1948 that the first modern clinical trial in which patients were randomized to different treatment and control groups was reported in the literature. Much of the research of this period was informal and unsystematic.Thus, it is not surprising that the physician’s authority to make treatment decisions extended to treatments that were innovative or experimental, regardless of whether these innovative treatments were the subject of formal scientific investigation. What is perhaps more surprising is that physicians often acted the same way—that... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:No-Self, Dōgen, the Senika Doctrine, and Western Views of SoulGerhard FadenNo-Self Versus SoulFrom the very beginning of Buddhism, the concept of no-self (P. anattā, J. muga) has been at the heart of Buddhist thought. Based on this concept, Buddhist apologetics rejected the concept of Atman in the Upanishads as well as Western concepts of soul. Christian authors, on the other hand, see an unbridgeable abyss between what they call (...) "Christian personalism" and Buddhist "rejection of souls."1 However, is there really such a clear-cut distinction? Posing this question means denying it. The no-self doctrine is one of the most intricate concepts within philosophy, and words like "self" and "soul" have countless interpretations. It seems to me that the Buddhist tradition itself has not always realized the crucial point of its fundamental doctrine, just as the Western concepts of "person" and "soul" more often than not fell behind the achievements of Plato and the New Testament. Especially the Theravāda line of Buddhism has developed a very counterintuitive picture of what it is to be a human person. "There is suffering, but there is no self who suffers." The most outstanding philosopher of Mahāyāna Buddhism, Nāgārjuna (ca. 150-250), introduced a more convincing interpretation when he said that according to Buddha the self or soul does neither exist nor not exist. This interpretation too, no less than the Theravāda doctrine, can refer to the early epoch of Buddhism. In the Pāli suttas a monk named Vacchagotta asked the Buddha, "Is there a self?" The Buddha gave no response. Then Vacchagotta asked, "Is there no self?" Again the Buddha was silent.2 In any case, the teaching of no-self leaves room for many divergent interpretations. In this paper, I shall propose to understand it as an original view of what is my true being, a view that has analogues in traditional Western philosophy. The truth is one; philosophy has to demonstrate that the different doctrines are nothing but aspects of a single universe. As for the dogmatic tenets of each religion, I would propose to see them like educators of the individual's thought: they set limits, develop abilities, suggest lines of sight, and the like. [End Page 41]The Concept of No-self in Pāli BuddhismIn the limited space of this essay, I can only give some marginal remarks. For a first approach, let us look at the origins of the no-self concept in the scriptures of Pāli Buddhism. They show clearly the aim of that doctrine: it consists in the liberation from objectifying theories of the soul. In the canonical texts, we find repeatedly the formula of rejecting the five aggregates, the so-called "heaps" (Skt. skhandha, P. khandha) that form the phantom of a persistent ego: body, sensation, conceptualization, volitions, and consciousness. None of these things is really mine. The Buddha tells to his disciples as follows: "Suppose, bhikkhus, people were to carry off the grass, sticks, branches, and foliage in this Jeta's Grove, or to burn them, or to do with them as they wish. Would you think: 'People are carrying us off, or burning us, or doing with us as they wish'?" Of course, the disciples do not think so. It is neither their self nor what belongs to their self. In the same way, the Buddha instructs them to think, the ear is not yours, and the mind is not yours, and so on, and to abandon it all.3In other words, by the teaching of anattā the Buddha invites his disciples to cease identifying their true being with things like body or consciousness. Only what really is mine can be my self. The khandhas seem to be mine. To a certain degree, I can dispose of them. However, really they are not mine; on the contrary, they are my master. The teaching of no-self does not originally mean there is no self, but nothing in this world can be my self. What is my self can never be taken from me. I cannot dispose of it, and on the other... (shrink)

In this article, I argue that Powers and Faden’s non-ideal, comprehensive theory of justice cannot keep in line with the proposed moderateness of their essentialist approach. My argument is as follows: Powers and Faden’s comprehensive theory of justice contravenes the thrust of moderate essentialism, in claiming that their theory values health for its own sake. Why do they define their conception of justice as valuing health for its own sake when it is likely to be incongruous with their (...) essentialist approach? To understand this, we should examine their sufficientarian proposal. There are two requirements for plausible sufficientarianism. The first requirement is to specify the threshold below which people are seriously deprived and must be urgently benefited in a non-arbitrary manner. The second requirement is that sufficientarianism should be sensitive to certain inequalities above the threshold. Powers and Faden’s approach convincingly meets the first requirement. However, the non-ideal aspect of their approach, which is key to meeting the second requirement, makes it explicit that at least one of the listed dimensions of well-being must be valued for their own sake. This is not reconcilable with their own characterization of moderate essentialism. For this reason, we should conclude that Powers and Faden fail to argue for moderate essentialism. (shrink)

Публикация рассчитана как на специалистов, так и на широкий круг читателей.

Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such (...) framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion. (shrink)

T︠S︡ivilizat︠s︡ionnai︠a︡ sushchnostʹ sovremennogo obrazovanii︠a︡ -- Sot︠s︡ialʹno-kulʹturnoe vzaimodeĭstvie kak osnova pedagogicheskogo sotvorchestva v situat︠s︡ii t︠s︡ivilizat︠s︡ionnykh preobrazovaniĭ -- Nat︠s︡ionalʹnai︠a︡ sistema obrazovanii︠a︡ Belarusi v ėpokhu tekhnogennoĭ t︠s︡ivilizat︠s︡ii i unifikat︠s︡ii kulʹtur.

Unpublished writing on Jaina doctrines, philosophy, rituals, tirthankars, Gujarati Jain poets and their works.