ABSTRACT Fast forward 50 years into the future. A look back at what occurred in the field of bioethics since 2010 reveals that a conference in 2050 commemorated the death of bioethics. In a steady progression over the years, the field became increasingly fragmented and bureaucratized. Disagreement and dissension were rife, and this once flourishing, multidisciplinary field began to splinter in multiple ways. Prominent journals folded, one by one, and were replaced with specialized publications dealing with genethics, (...) reproethics, nanoethics, and necroethics. Mainstream bioethics organizations also collapsed, giving way to new associations along disciplinary and sub‐disciplinary lines. Physicians established their own journals, and specialty groups broke away from more general associations of medical ethics. Lawyers also split into three separate factions, and philosophers rejected all but the most rigorous, analytic articles into their newly established journal. Matters finally came to a head with global warming, the world‐wide spread of malaria and dengue, and the cost of medical treatments out of reach for almost everyone. The result was the need to develop plans for strict rationing of medical care. At the same time, recognition emerged of the importance of the right to health and the need for global justice in health. By 2060, a spark of hope was ignited, opening the door to the resuscitation of bioethics and involvement of the global community. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Future of Environmental PhilosophyBen A. Minteer (bio)I think we should be deeply concerned about the future of environmental philosophy. It is the most marginalized of the applied ethics fields (which are often marginalized as a whole within traditional philosophy departments) and with few exceptions, it still has not made significant inroads into neighboring territories—including schools of public policy, natural resources/environment, planning, life sciences, and so on. (...) In my opinion, this is partly due to the general ideological pitch of the field and its narrow methodological orientation, at least historically. The neglect of alternative methods of inquiry, especially qualitative and quantitative work in the social sciences, is particularly troubling.Environmental ethics also has an image problem. In my experience, most natural resource professionals, policy scholars, engineers, and life scientists view our field with considerable skepticism, shaking their heads at what they see as arcane debates that do not touch upon the issues and challenges that motivate their own work. Many of our colleagues in the natural and environmental social sciences, for example, have little patience for the kind of metaethical discussions about intrinsic value, moral pluralism, etc., that have captured much of our attention in the past. They do not see what these kinds of arguments contribute to the scientific, policy, and management curricula, or what they add to their graduate students' training, or to their own research proposals. Typically, if a role for an environmental ethicist is recognized in such settings, it is often just to plug a personnel hole in an National Science Foundation proposal or to serve as a third or fourth reader on a graduate studies committee. Environmental ethics is at best an elective pursuit, it is not seen as essential.I'll be the first to admit that I have blood on my hands here (as do all of us, at least to the extent we have spent time and energy on debates over metaphilosophical issues in the field). And, of course, just because our environmental science and policy colleagues often do not see the true value of the field does not mean that it has no value. Still, I worry that the field seems to be falling into the chasm between traditional philosophy departments and environmental science, policy, and management programs. It is frequently deemed too applied and practical by many [End Page 132] philosophy departments, and too esoteric for schools of public policy, life sciences, and so on. This is not a good situation.How can we fix the image problem? Perhaps one approach would be to develop more solid links with our bioethics cousins (both philosophically and institutionally). There is a revealing story here about the different fortunes of bio- and environmental ethics, and I think we might learn from the success of the former. There will be barriers to such an alliance, however, some of which are intellectual (e.g., the rejection of conventional ethical categories and theories by many environmental ethicists is not shared by most bioethicists) while others are institutional (e.g., What practical shape would a "clinical" model of environmental ethics take? What is the market for this service? and so on).Another route would be to provide more organized and systematic attention to emerging, large-scale environmental science and policy issues—climate change, sustainability, poverty alleviation, and biodiversity loss, to name a few—that are (unfortunately, given their seriousness) viewed as "growth areas" in environmental science and policy studies. At my own institution (Arizona State University) we are moving away from an older departmental and disciplinary model to a more integrative institutional form and a transdisciplinary research culture. So, for example, we have a new school of global studies, a new school of sustainability, and so on. These are composed of a range of disciplines cutting across the natural, technical, and social sciences. There is certainly room in these initiatives and programs for a practical and progressive environmental ethics, but it must be conversant in subjects such as intergenerational equity, conservation science, economic valuation, environmental justice, and the normative dimensions of environmental science policy. I think there is an important role for us to play in these sorts of endeavors (which are popping... (shrink)

Bioethics in the twenty‐first century is confronting what one might call “collective‐impact problems.” The ethics guidance and policies that are developed to address these kinds of problems will affect not only individuals but everyone living and future generations too. With many collective‐impact problems, all parties will eventually be worse off if there is a failure to develop solutions to head off damage to the shared environment. However, the effects are not felt equally throughout and across societies; some groups (...) are hit far worse. To address collective‐impact problems, bioethics needs to recalibrate. Our field, and especially American bioethics, should find a better balance between individual rights and the best interests of the group, develop more robust tools for examining structural inequities that damage people's health and well‐being, and study how to engage the public in learning about and shaping ethics guidance for these complex problems. (shrink)

Just Life reorients ethics and politics around the generativity of mothers and daughters rather than the right to property and the sexual proprieties of the Oedipal drama. Invoking two concrete universals – everyone is born of a woman and everyone needs to eat – Rawlinson rethinks labor and food as relationships that make ethical claims and sustain agency. Just Life counters the capitalization of bodies under biopower with the solidarity of sovereign bodies.

In The Future of Human Nature, Jürgen Habermas raises the question of whether the embryonic genetic diagnosis and genetic modification threatens the foundations of the species ethics that underlies current understandings of morality. While morality, in the normative sense, is based on moral interactions enabling communicative action, justification, and reciprocal respect, the reification involved in the new technologies may preclude individuals to uphold a sense of the undisposability of human life and the inviolability of human beings that is necessary (...) for their own identity as well as for reciprocal relations. Engaging with liberal bioethics and Catholic approaches to bioethics, the article clarifies how Habermas’ position offers a radical critique of liberal autonomy while maintaining its postmetaphysical stance. The essay argues that Habermas’ approach may guide the question of rights of future generations regarding germline gene editing. But it calls for a different turn in the conversation between philosophy and theology, namely one that emphasizes the necessary attention to rights violations and injustices as a common, postmetaphysical starting point for critical theory and critical theology alike. In 2001, Jürgen Habermas published a short book on questions of biomedicine that took many by surprise.[1] To some of his students, the turn to a substantive position invoking the need to comment on a species ethics rather than outlining a public moral framework was seen as the departure from the “path of deontological virtue,”[2] and at the same time a departure from postmetaphysical reason. Habermas’ motivation to address the developments in biomedicine had certainly been sparked by the intense debate in Germany, the European Union, and internationally on human cloning, pre-implantation genetic diagnosis, embryonic stem cell research, and human enhancement. He turned to a strand of critical theory that had been pushed to the background by the younger Frankfurt School in favor of cultural theory and social critique, even though it had been an important element of its initial working programs. The relationship of instrumental reason and critical theory, examined, among others, by Max Horkheimer, Theodor W. Adorno, and Herbert Marcuse and taken up in Habermas’ own Knowledge and Interest and Theory of Communicative Action became ever-more actual with the development of the life sciences, human genome analysis, and genetic engineering of human offspring. Today, some of the fictional scenarios discussed at the end of the last century as “science fiction” have become reality: in 2018, the first “germline gene-edited” children were born in China.[3] Furthermore, the UK’s permission to create so-called “three-parent” children may create a legal and political pathway to hereditary germline interventions summarized under the name of “gene editing.”In this article, I want to explore Habermas’ “substantial” argument in the hope that philosophy and theology become allies in their struggle against an ever-more reifying lifeworld, which may create a “moral void” that would, at least from today’s perspective, be “unbearable”, and for upholding the conditions of human dignity, freedom, and justice. I will contextualize Habermas’ concerns in the broader discourse of bioethics, because only by doing this, his concerns are rescued from some misinterpretations.[1] Jürgen Habermas, The Future of Human Nature.[2] Ibid., 125, fn. 58. 8[3] Up to the present, no scientific publication of the exact procedure exists, but it is known that the scientist, Jiankui He, circumvented the existing national regulatory framework and may have misled the prospective parents about existing alternatives and the unprecedented nature of his conduct. Yuanwu Ma, Lianfeng Zhang, and Chuan Qin, "The First Genetically Gene‐Edited Babies: It's “Irresponsible and Too Early”," Animal Models and Experimental Medicine ; Matthias Braun, Meacham, Darian, "The Trust Game: Crispr for Human Germline Editing Unsettles Scientists and Society," EMBO reports 20, no. 2. (shrink)

The topic of epistemic injustice in global health ethics is complex, important and vast. While presenting as nuanced and complete a picture of the challenge as we possibly could, we were acutely aware of our positionality and how it gave us a certain viewpoint that would need to be expanded by others with different positions and experiences. We were, therefore, delighted to receive the collected commentaries by Atuire,1 Abimbola,2 Frimpong-Mansoh,3 Nyamnjoh and Ewuoso,4 Tangwa,5 Ambrogi et al.6 We would like to (...) thank these authors for furthering our account by raising questions, pointing out gaps or complementing our analysis. The points raised by these authors—and many points that will undoubtedly be raised by others in future—should be critically engaged with as we collectively define and work towards a more epistemically just global health ethics. Specifically, two points stand out. First, Frimpong-Mansoh accurately diagnoses our ambiguity about being drawn into debates about relativism in bioethics. We …. (shrink)

Liberal proponents of genetic engineering maintain that developing human germline modification technologies is morally desirable because it will result in a net improvement in human health and well-being. Skeptics of germline modification, in contrast, fear evolutionary harms that could flow from intervening in the human germline, and worry that such programs, even if well intentioned, could lead to a recapitulation of the scientifically and morally discredited projects of the old eugenics. Some bioconservatives have appealed as well to the value of (...) retaining our “given” human biological nature as a reason for restraining the development and use of human genetic modification technologies even where they would tend to increase well-being. In this article, I argue that germline intervention will be necessary merely to sustain the levels of genetic health that we presently enjoy for future generations—a goal that should appeal to bioliberals and bioconservatives alike. This is due to the population-genetic consequences of relaxed selection pressures in human populations caused by the increasing efficacy and availability of conventional medicine. This heterodox conclusion, which I present as a problem of intergenerational justice, has been overlooked in medicine and bioethics due to certain misconceptions about human evolution, which I attempt to rectify, as well as the sordid history of Darwinian approaches to medicine and social policy, which I distinguish from the present argument. (shrink)

Health care is ubiquitous in the industrialized world. Yet, every medical development, technique, and procedure impacts the environment. Green bioethics synthesizes environmental ethics and biomedical ethics, thus creating an interdisciplinary approach to sustainable health care. Notably, green bioethics addresses not the structure of environmental sustainability in health-care institutions but the sustainability of individual health-care offerings. It parallels traditional biomedical ethics by providing four principles for ethical guidance: distributive justice, resource conservation, simplicity, and ethical economics. Through these four (...) principles, green bioethics presents a coherent framework for evaluating the sustainability of medical developments, techniques, and procedures. The future of our world may very well depend on how effectively we halt ecological destruction and conserve our resources in all areas of life. The principles of green bioethics, outlined in this book, will advance sustainability in health care. (shrink)

The South African government announced the much-discussed stay-at-home order between March 27 and April 30, 2020, during what was known as lockdown level 5, which meant that citizens were not allowed to leave their homes. The objective of this study is to assess the stay-at-home order against the global principles of the UDBHR. It is deducible that, in reference to the UDBHR, the government possessed the right to curtail individual liberty, thereby not infringing on Article 5 of the UDBHR and (...) therefore, in this context, passes the test of the UDBHR. However, it remains uncertain at present whether the limitation of freedom imposed by the South African stay-at-home order was successful in controlling the spread of COVID-19 and protecting individuals from harm. Initial investigations also indicate that individuals who are particularly vulnerable may not have received equitable treatment in accordance with the principle outlined in Article 10, therefore, it can be cautiously and modestly argued that the stay-at-home order does not withstand scrutiny when assessed against the UDBHR. Given the continued discussion about the efficacy of limiting freedom to control the spread of COVID-19, and the growing conviction that the advancement of justice is being called into question, the notion of least restriction ought to be considered seriously. Ten Have (2022) is correct in asserting that global bioethics should also seriously consider other principles beyond an almost exclusive focus on limiting individual freedom. The preliminary conclusion is that the potential implementation of the stay-at-home order in the future must be seriously reconsidered. (shrink)

Climate change poses a challenge to bioethics due to overpopulation and a declining quality of life, among other factors. In this article, we discuss four scenarios of possible human development in the near future. Two of them are horrible scenarios. One of them assumes that living conditions will significantly deteriorate and people will live in great poverty. The second of the horrible scenarios is one in which a large part of humanity will die. Two other, non-horrible scenarios offer (...) more optimism, either because of faith in technological capabilities, or because of faith in the development of human solidarity and social justice. In this article, we show why rational calculation suggests considering the horrible scenarios as the most realistic. (shrink)

The American Journal of Bioethics, Volume 12, Issue 6, Page 53-55, June 2012.

In this paper I argue that bioethics is in crisis and that it will not have a future unless it begins to embrace a more Socratic approach to its leading assumptions. The absence of a critical and sceptical spirit has resulted in little more than a dominant ideology. I focus on three key issues. First, that too often bioethics collapses into medical ethics. Second, that medical ethics itself is beset by a lack of self-reflection that I characterize (...) here as a commitment to three dogmas. Third, I offer a more positive perspective by suggesting how bioethics may benefit from looking towards public health ethics as a new source of inspiration and direction. (shrink)

Climate change has substantial impacts on public health and safety, disease risks and the provision of health care, with the poor being particularly disadvantaged. Management of the associated health risks and changing health service requirements requires adequate responses at local levels. Health-care providers are central to these responses. While climate change raises ethical questions about its causes, impacts and social justice, medicine and bioethics typically focus on individual patients and research participants rather than these broader issues. We broaden (...) this focus by examining awareness among health-care providers in the Caribbean region, where geographic and socioeconomic features pose particular vulnerabilities to climate change. In focus groups, Caribbean providers described rises in mosquito-borne, flood-related, heat-related, respiratory and mental illnesses, and attributed these to local impacts of climate change. Their discussions showed that the significance of these impacts differs in different Caribbean nations, raising policy and social justice questions. Bioethics and public health ethics are situated to frame, inform and initiate public and policy dialog about values and scientific evidence associated with climate change. We urge readers to initiate such dialog within their own institutions about the context-dependent nature of the burdens of climate change, and values and policies that permit it to worsen. (shrink)

Background Intersectionality is a concept that originated in Black feminist movements in the US-American context of the 1970s and 1980s, particularly in the work of feminist scholar and lawyer Kimberlé W. Crenshaw. Intersectional approaches aim to highlight the interconnectedness of gender and sexuality with other social categories, such as race, class, age, and ability to look at how individuals are discriminated against and privileged in institutions and societal power structures. Intersectionality is a “traveling concept”, which also made its way into (...) bioethical research. Methods We conducted a systematic review to answer the question of where and how the concept of intersectionality is applied in bioethical research. The PubMed and Web of Science databases were systematically searched and 192 articles addressing bioethical topics and intersectionality were finally included. Results The qualitative analysis resulted in a category system with five main categories: (1) application purpose and function, (2) social dimensions, (3) levels, (4) health-care disciplines and academic fields, and (5) challenges, limitations, and critique. The variety of academic fields and health-care disciplines working with the concept ranges from psychology, through gynaecology to palliative care and deaf studies. Important functions that the concept of intersectionality fulfils in bioethical research are making inequities visible, creating better health data collections and embracing self-reflection. Intersectionality is also a critical praxis and fits neatly into the overarching goal of bioethics to work toward social justice in health care. Intersectionality aims at making research results relevant for respective communities and patients, and informs the development of policies. Conclusions This systematic review is, to the best of our knowledge, the first one to provide a full overview of the reference to intersectionality in bioethical scholarship. It creates a basis for future research that applies intersectionality as a theoretical and methodical tool for analysing bioethical questions. (shrink)

Bioethics' interdisciplinary base -- Patient-centered care -- Evidence-based medicine and pay-for-performance -- Community dialogue -- Overview : bioethics, power, and learning to see -- Cross-cultural concerns -- Race and health disparities -- Disabilities -- Environmental and global issues -- New technologies -- Conclusion.

In this essay, we suggest practical ways to shift the framing of crisis standards of care toward disability justice. We elaborate on the vision statement provided in the 2010 Institute of Medicine (National Academy of Medicine) “Summary of Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations,” which emphasizes fairness; equitable processes; community and provider engagement, education, and communication; and the rule of law. We argue that interpreting these elements through disability justice entails a commitment (...) to both distributive and recognitive justice. The disability rights movement's demand “Nothing about us, without us” requires substantive inclusion of disabled people in decision‐making related to their interests, including in crisis planning before, during, and after a pandemic like Covid‐19. (shrink)

The Covid‐19 pandemic has concentrated bioethics attention on the “lifeboat ethics” of rationing and fair allocation of scarce medical resources, such as testing, intensive care unit beds, and ventilators. This focus drives ethics resources away from persistent and systemic problems—in particular, the structural injustices that give rise to health disparities affecting disadvantaged communities of color. Bioethics, long allied with academic medicine and highly attentive to individual decision‐making, has largely neglected its responsibility to address these difficult “upstream” issues. It (...) is time to broaden our teaching, research, and practice to match the breadth of the field in order to help address these significant societal inequities and unmet health needs. (shrink)

A global trend of institutionalised pronatalism situates low fertility as a site of demographic disaster – positioning primarily women’s bodies as both its cause and solution. In light of such demographic dread, assisted reproductive technologies (ART) may be utilized by pronatalist states as a strategy for fertility recovery, rather than as a benefit for individual aspiring parents. In other words, ARTs are at risk of being co-opted by nation-states for problematic demographic designs which do not advance emancipatory goals. The underlying (...) issue of pronatalism, however, is not always explicitly acknowledged in feminist bioethics as a barrier to ethical ART usage. In my paper, I argue that it would be a mistake to assume ART can be used for emancipatory ends if we do not, at the same time, critically investigate its connections to institutionalised pronatalism. (shrink)

Contemporary biomedical ethics and environmental ethics share a common ancestry in Aldo Leopold's and Van Rensselaer Potter's initial broad visions of a connected biosphere. Over the past five decades, the two fields have become strangers. Public health ethics, a new subfield of bioethics, emerged from the belly of contemporary biomedical ethics and has evolved over the past 25 years. It has moved from its traditional concern with the tension between individual autonomy and community health to a wider focus on (...) social justice and solidarity. Public health has a broad focus that includes individual, community, and environmental health. Public health ethics attends to these broad commitments reflected in the increasing concern with the connectedness of health of individuals to the health of populations, to the health of animals, to the health of the environment; it is well situated to reconnect all three “fields” of ethics to promote a healthier planet. (shrink)

In light of this empirical study of who bioethicists are and what their values are and then answering the question “What is the future of bioethics?,” we think it’s important to place this question...

We appreciate the helpful commentaries on our paper, ‘AI and the falling sky: interrogating X-Risk’.1 We agree with many points commentators raise, which opened our eyes to concerns we had not previously considered. This reply focuses on the tension many commentators noted between AI’s existential risks (X-Risks) and justice here and now. In ‘Existential risk and the justice turn in bioethics’, Corsico frames the tension between AI X-Risk and justice here and now as part of a (...) larger shift within bioethics.2 They think the field is increasingly turning away from ‘big picture’ questions new technologies raise and focusing on narrower justice concerns of less significance. They compare our paper’s emphasis on justly transitioning to more AI-centred societies with the approach of environmentalists fretting about human protection against climate change while losing sight of the need to protect the planet and all living things. Corsico doubts there is much point to pressing for ‘justice on a dead planet’, so too Corsico questions our concern with just transitions. Presumably, that matters little if intelligent life on Earth is destroyed. Corsico’s recommends bioethicists return to big questions, like: ‘Should we develop AI at all, given AI X-Risk?’. Yet this question is increasingly moot. The genie is already out of the bottle. The Future of Life Institute’s 2023 call for a temporary pause on training AI systems more powerful than ChatGPT fell on deaf ears, in part because freely accessible source codes enable anyone to train systems and create AI applications.3 The focus now must be managing the genie. While we take AI X-Risk seriously, …. (shrink)

While experience often affords important knowledge and insight that is difficult to garner through observation or testimony alone, it also has the potential to generate conflicts of interest and unrepresentative perspectives. We call this tension the paradox of experience. In this paper, we first outline appeals to experience made in debates about access to unproven medical products and disability bioethics, as examples of how experience claims arise in bioethics and some of the challenges raised by these claims. We (...) then motivate the idea that experience can be an asset by appealing to themes in feminist and moral epistemology, distinguishing between epistemic and justice-based appeals. Next, we explain the concern that experience may be a liability by appealing to empirical work on cognitive biases and theoretical work about the problem of partial representation. We conclude with preliminary recommendations for addressing the paradox and offer several questions for future discussion. (shrink)

Bioethics has a founding story in which medical paternalism, the interference with the autonomy of patients for their own clinical benefit, was an accepted ethical norm in the history of Western medical ethics and was widespread in clinical practice until bioethics changed the ethical norms and practice of medicine. In this paper I show that the founding story of bioethics misreads major texts in the history of Western medical ethics. I also show that a major source for (...) empirical claims about the widespread practice of medical paternalism has been misread. I then show that that bioethics based on its founding story deprofessionalizes medical ethics. The result leaves the sick exposed to the predatory power of medical practitioners and healthcare organizations with only their autonomy-based rights to non-interference, expressed in contracts, to protect them. The sick are stripped of the protection afforded by a professional, fiduciary relationship of physicians to their patients. Bioethics based on its founding story reverts to the older model of a contractual relationship between the sick and medical practitioners not worthy of intellectual or moral trust (because such trust cannot be generated by what I call ‘deprofessionalizing bioethics’). On closer examination, bioethics based on its founding story, ironically, eliminates paternalism as a moral category in bioethics, thus causing bioethics to collapse on itself because it denies one of the necessary conditions for medical paternalism. Bioethics based on its founding story should be abandoned. (shrink)

This is the first book to bring West and East together in a broad investigation of contemporary bioethics. A distinguished international team of experts presents original research addressing issues that emerge from new medical technologies, address global challenges arising from social change, and set the agenda for the future.

There are many ways of enhancing human performance. For military aviation in general, and for spaceflight in particular, the most important tools are selection, training, equipment, pharmacology, and surgery. In the future, genetic manipulation may be feasible. For each of these tools, the specific modalities available range from the ethically acceptable to the ethically unacceptable. Even when someone consents to a particular procedure to enhance performance, the action may be ethically unacceptable to society as a whole and the burden (...) of risk for the individual may be too great. In addition, there are several characteristics that define the quality and the acceptability of the consent. Each method of enhancing performance will be examined in the context of the principles of medical ethics in a western society: autonomy, non-maleficence, beneficence, and justice. The aim is to draw the attention of aeromedical practitioners to the complexities of ethical dilemmas such as this particular one in order to help them to develop a morally justifiable code of practice that balances society’s needs against individual ambitions and corporate goals. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:In the Belly of the Whale:Some Thoughts on Preserving the Integrity of the New Bioethics CommissionF. Daniel Davis (bio)10 July 2010. Washington, D.C. President Obama's Presidential Commission for the Study of Bioethical Issues has just concluded its inaugural meeting, designed as a primer—the first of three that it plans to hold—on synthetic biology. As a topic for deliberation by a national bioethics commission, "synbio" is ideal. A (...) cloud of equipoise hangs over the practical implications of recent developments in this, the latest phase in the evolution of biotechnology—a seemingly genuine uncertainty about the need for additional mechanisms of oversight to mitigate potential risks to biosafety or biosecurity. Despite these concerns, its advocates and practitioners enthusiastically champion the prospect of eventual, perhaps significant benefits to be gained with progress in "synbio," including, for example, enhanced processes for the mass production of vaccines and biofuels. And yet like the advent of recombinant DNA technologies in the mid-1970s, synthetic biology has generated not only hope for benefits and concern for risks, but also questions variously described as "deep," "profound," "fundamental," and "philosophical": Is the capacity to synthesize novel, living entities yet another technological invitation to hubris on the part of humankind? Will that capacity alter the relationship between humankind and nature? How should we think about the moral status of living entities created de novo in the laboratory? Should we even care? How will wide-scale applications of synthetic biology tip the scales of social justice? And finally, the democratization of synthetic biology, the growth of DIY-BIO (do-it-yourself-biology) communities beyond the usual scientific arenas of academia and industry, has infused old questions about scientific freedom and responsibility with new complexities—all in the midst of an American public that is reportedly unaware and uneducated about this new chapter in the often triumphant, unsettling history of biotechnology.Thus, the topic of synthetic biology presents the new commission with several possibilities. It could very well make a substantial contribution to public policies responsive to both the current capabilities and the possible trajectories of [End Page 291] these emergent biotechnologies. The very fact that the President explicitly asked the Commission to take up the topic and report back to him (in six months) means that that potential is especially promising. It could, as well, delve into the "deeper" philosophical questions that "synbio" raises with the aim of bringing both depth and breadth to the tasks of critically analyzing and reflecting upon what currently is known and what, with regard to the future, can only be glimpsed of this amalgam of the life sciences, engineering, and other disciplines. The Commission could also set its sights on diminishing the apparent deficit in public understanding of these biotechnologies. And finally, with this topic as well as any others it takes up, the Commission, along with the administration that established it, could make an effort to reinvigorate public bioethics in the United States. At the very least, in the sobering light of experience with the President's Council on Bioethics, certain actions or behaviors could be avoided in the interests of preserving the integrity—the moral and political legitimacy—of the new commission. Although each of these possibilities warrants further explanation, my focus here is the final one.The Belly of the WhaleIn several decades, some future historian of public bioethics in the U.S. will be able to look back on the bioethics commissions established to date and offer an insightful, comprehensive—maybe even magisterial—account of their beginnings and endings, their deliberations and the political forces that shaped them, and perhaps most important, their ultimate value as public bodies. Lacking the strategic perch of historical distance, and fresh from the trenches, I can only offer a few somewhat informed but partial observations and arguments about public bioethics in the context of contemporary American politics, acknowledging at the outset that my thoughts are open to, and needful of, critical amendment or supplement by others.In the U.S., bioethics commissions are political creatures, established through the authority of the Congress or the President for the purpose of providing counsel to the legislative and/or executive... (shrink)

Antimicrobial resistance has been termed a ‘silent pandemic’, a ‘hidden killer.’ This language might indicate a threat of significant future harm to humans, animals, and the environment from resistant microbes. If that harm is uncertain but serious, the precautionary principle might apply to the issue, and might require taking ‘precautionary measures’ to avert the threat of antimicrobial resistance, including stewardship interventions like antibiotic prescription caps, bans on certain uses in farming sectors, and eliminating over-the-counter uses of antibiotics. The precautionary (...) principle is a useful tool in ethical analyses of antimicrobial stewardship measures, but as I argue in this article, it ought not be used as a standalone tool. The principle considers the magnitude of harms to be averted and those arising from precautionary measures, but—importantly—it does not consider the distribution of those harms. That may raise issues of social justice if the harms of stewardship measures befall already disadvantaged populations. To avoid this blind spot in ethical analysis using the precautionary principle, it ought never be used alone, but rather always alongside justice-considering ethical concepts such as reciprocity, benefit-sharing, or a just transition. (shrink)

Abstract:The end of the last century was a particularly vibrant period for feminist bioethics. Almost two decades on, we reflect on the legacy of the feminist critique of bioethics and investigate the extent to which it has been successful and what requires more attention yet. We do this by examining the past, present, and future: we draw out three feminist concerns that emerged in this period—abstraction, individualism, and power—and consider three feminist responses—relationality, particularity, and justice—and we (...) finish with some thoughts about the future. (shrink)

One of the most ambitious and sophisticated recent approaches to provide a theory of global health justice is Sridhar Venkatapuram's recent work. In this commentary, we first outline the core idea of Venkatapuram's approach to global health justice. We then argue that one of the most important elements of the account, Venkatapuram's basis of global health duties, is either too weak or assumed implicitly without a robust justification. The more explicit grounding of the duty to protect and promote (...) health capabilities is based on Martha Nussbaum's version of the capability approach. We argue that this foundation gives rise to humanitarian duties rather than duties of justice proper. Venkatapuram's second argument from the social determinants of health thesis is instead a stronger candidate for grounding duties of justice. However, as a justificatory argument, it is only alluded to and has not yet been spelled out sufficiently. We offer plausible justificatory steps to fill this gap and draw some implications for global health action. We believe this both strengthens Venkatapuram's approach and serves to broaden the basis for future action in the area of global health. (shrink)

I reflect on the past, present, and future of the field of bioethics. In so doing, I offer a very situated overview of where bioethics has been, where it now is, where it seems to be going, where I think we could do better, and where I dearly hope the field will be heading. I also propose three ways of re‐orienting our theoretic tools to guide us in a new direction: (1) adopt an ethics of responsibility; (2) (...) explore the responsibilities of various kinds of actors and relationships among them; (3) expand the types of participants engaged in bioethics. (shrink)

An ethical conflict arises when we must perform research in the interest of future patients, but that this may occasionally injure the interests of today''s patients. In the case of cognitively impaired persons, the question arises whether it is compatible with humane healthcare not only to treat, but also to use these patients for research purposes. Some bioethicists and theologians have formulated a general duty of solidarity, also pertaining to cognitively impaired persons, as a justification for research on these (...) persons. If one examines this thesis from the theory of justice according to John Rawls, it is revealed that such a duty of solidarity cannot necessarily be extrapolated from Rawls' conception of justice. This is at least true of Rawls' difference principle, because accordingto the difference principle only those measures are justifiable which serve the interest of the respective least well off. Those measures which would engender additional injury for the least well off could not be balanced by any utility according to Rawls. However, John Rawls' difference principle is subordinate to the first principle, which is that each person has an equal right to the most extensive basic liberty compatible with the same liberty for others. These primary goods are determined by the freedom and integrity of the person. This integrity of decisionally impaired persons would be in danger if one would abstain from research and thus forego the increase in knowledge related to their disease. Thus one could conclude, at least from Rawls' first principle, that society must take on a duty to guarantee the degrees of freedom for cognitively impaired persons and thus also support the efforts for their healing. (shrink)

Background The field of nursing has long been concerned with ethical issues. The history of the nursing profession has a rich legacy of attention to social justice and to societal questions regarding issues of fairness, access, equity, and equality. Some nurses have found that their clinical experiences spur an interest in ethical patient care, and many are now nurse bioethicists, having pursued additional training in bioethics and related fields (e.g., psychology, sociology). Purpose The authors describe how the clinical (...) and research experiences of nurses give them a unique voice in the field of bioethics. Results Authors present reasons for the relative invisibility of nurse bioethicists, compared with physician, theologian, or philosopher bioethicists, as well as current efforts to increase the visibility of nurse bioethicists. They also describe four specific areas where nurse bioethicists have made and continue to make important contributions: as ethics consultants to colleagues in hospitals and other settings; as bioethics researchers or as advisers to researchers conducting trials with human subjects; as educators of trainees, patients and families, healthcare providers, and the public; and in helping to draft humane and ethical policies for the care of vulnerable patients and underserved populations. Conclusion Nurse bioethicists are central to the future goals of healthcare bringing a unique perspective to the day-to-day ethical challenges of both clinical care and research, as well as to the education of health professionals and the public. (shrink)

Let’s face it, the humanities are in trouble. Last year, in The Chronicle of Higher Education, Thomas H. Benton warned prospective graduate students to avoid doctoral studies in the humanities. His rationale: a job market down 40%, the improbability of tenure, the more certain prospect of life as an adjunct, and eventual outright exile from one’s chosen field. Benton, the pen name of William Pannapacker, an associate professor of English at Hope College in Holland, Michigan, pulled no punches. His piece (...) was entitled, “Graduate School in the Humanities: Just Don’t Go.”. (shrink)

A recent trend in bioethics has highlighted the decisive role that solidarity plays in global health. However, given the impact and extent of the effects of climate change, which reach beyond present generations, it is important to consider whether this concept can be applied intergenerationally. Does it make sense to talk about solidarity with future generations? The objective of this article is to explore ‘amplified solidarity’, a new concept of solidarity that explains our obligations towards the health and (...) quality of life of future generations. The analysis of this concept is structured as follows: I first establish the moral relevance of future people and then investigate the traits of amplified solidarity, its challenges, and its relationship with other key principles. I propose that amplified solidarity needs both a critical imagination to be projected towards the future and an institutional framework to correct health injustices across an intergenerational timescale. Solidarity forms a potent triangular constellation with responsibility and justice to fight against global and intergenerational injustices. (shrink)

The term “globalization” was popularized by Marshall McLuhan in War and Peace in the Global Village. In the book, McLuhan described how the global media shaped current events surrounding the Vietnam War [1] and also predicted how modern information and communication technologies would accelerate world progress through trade and knowledge development. Globalization now refers to a broad range of issues regarding the movement of goods and services through trade liberalization, and the movement of people through migration. Much has also been (...) written on the global effects of environmental degradation, population growth, and economic disparities. In addition, the pace of scientific development has accelerated, with both negative and positive implications for global health. Concerns for national health transcend borders, with a need for shared human security and an enhanced role for international cooperation and development [2]. These issues have significant bioethical implications, and thus a renewed academic focus on the ethical dimensions of public health is needed. Future developments in science and health policy also require a firm grounding in bioethical principles. These core principles include beneficence; nonmaleficence ; respect for persons and human dignity ; and attention to equity and social justice. According to the World Health Organization [3], global ethical approaches should monitor and update ethical norms for research, as necessary; anticipate ethical implications of advances in science and technology for health; apply internationally accepted codes of ethics; ensure that agreed standards guide future work on the human genome; and ensure that quality in health systems and services is assessed and promoted. (shrink)

This paper reflects on the relationship between theory and practice in bioethics, by using various concepts drawn from debates on innovation in healthcare research—in particular debates around how best to connect up blue skies ‘basic’ research with practical innovations that can improve human lives. It argues that it is a mistake to assume that the most difficult and important questions in bioethics are the most abstract ones, and also a mistake to assume that getting clear about abstract cases (...) will automatically be of much help in getting clear about more complex cases. It replaces this implicitly linear model with a more complex one that draws on the idea of translational research in healthcare. On the translational model, there is a continuum of cases from the most simple and abstract to the most concrete and complex. Insights need to travel in both directions along this continuum—from the more abstract to the more concrete and from the more concrete to the more abstract. The paper maps out some difficulties in moving from simpler to more complex cases, and in doing so makes recommendations about the future of bioethics. (shrink)

ABSTRACT One of the most ambitious and sophisticated recent approaches to provide a theory of global health justice is Sridhar Venkatapuram's recent work. In this commentary, we first outline the core idea of Venkatapuram's approach to global health justice. We then argue that one of the most important elements of the account, Venkatapuram's basis of global health duties, is either too weak or assumed implicitly without a robust justification. The more explicit grounding of the duty to protect and (...) promote health capabilities is based on Martha Nussbaum's version of the capability approach. We argue that this foundation gives rise to humanitarian duties rather than duties of justice proper. Venkatapuram's second argument from the social determinants of health thesis is instead a stronger candidate for grounding duties of justice. However, as a justificatory argument, it is only alluded to and has not yet been spelled out sufficiently. We offer plausible justificatory steps to fill this gap and draw some implications for global health action. We believe this both strengthens Venkatapuram's approach and serves to broaden the basis for future action in the area of global health. (shrink)

While functioning quite well for many years, the bioethics profession is in crisis. John H. Evans closely examines the history of the bioethics profession, and based on the sociological reasons the profession evolved as it did, proposes a radical solution to the crisis.

Ethics in the anthropocene -- Atmospheric powers: climate change and moral incompetence -- Christian ethics and unprecedented problems -- Global ethics: moral pluralism and planetary problems -- Sustainability science and the ethics of wicked problems -- Toxic wombs and the ecology of justice -- Impoverishment and the economy of desire -- Intergenerational risk and the future of love -- Sustaining grace.

Understanding the basics of ethics is essential for a physical therapist. Diagnostic skills, technical expertise, and knowledge of the body are insufficient; being a good clinician requires a moral education as well. Bioethics in Physical Therapy: A Reader helps students develop a deeper understanding of moral principles and their philosophical underpinnings. The text encourages readers to exercise their moral imaginations and prepares them to respond to professional conflicts in an ethical manner. The reader is organized in seven units. The (...) text begins with an introduction to classical moral theories, the fundamental philosophical pillars of biomedical ethics, and a history of ethics in physical therapy. Additional units explore such topics as moral distress and the choice to be ethical, acting with integrity in the face of uncertainty, and the importance of hope in the patient encounter. Students learn about moral courage, the broad reach of justice in the medical field, and the lived experience of illness. Each unit features an opening scenario, a section on cultivating professional values, introductions to the key topic and the readings, comprehension questions, and post-reading critical thinking questions that reference the opening scenario. Written to be engaging and accessible, Bioethics in Physical Therapy: A Reader is designed to help future therapists understand the importance of ethics in practice. It is an ideal resource for all courses in the discipline. (shrink)

Industrialisation, urbanisation and economic development have produced unprecedented improvements in human health. They have also produced unprecedented exploitation of Earth’s life support systems, moving the planet into a new geological epoch, the Anthropocene—one defined by human influence on natural systems. The health sector has been complicit in this influence. Bioethics, too, must acknowledge its role—the environmental threats that will shape human health in this century represent a ‘perfect moral storm’ challenging the ethical theories of the last. The US conservationist (...) Aldo Leopold saw this gathering storm more clearly than many, and in his Land Ethic describes the beginnings of a route to safe passage. Its starting point is a reinterpretation of the ethical relationship between humanity and the ‘land community’, the ecosystems we live within and depend upon; moving us from ‘conqueror’ to ‘plain member and citizen’ of that community. The justice of the Land Ethic questions many presuppositions implicit to discussions of the topic in biomedical ethics. By valuing the community in itself—in a way irreducible to the welfare of its members—it steps away from the individualism axiomatic in contemporary bioethics. Viewing ourselves as citizens of the land community also extends the moral horizons of healthcare from a solely human focus. Taking into account the ‘stability’ of the community requires intergenerational justice. The resulting vision of justice in healthcare—one that takes climate and environmental justice seriously—could offer health workers an ethic fit for the future. (shrink)

What makes the rule of law so special that it is to conscientiously punish the â oebadâ doers and reward the â oegoodâ onesâ "such that, where there is the rule of law, peace and order are to be expected, so that â oethe rule of law is better than the rule of any individualâ? Take the case of international law, as an illustration. While different international courts have been busy going after the killers of innocent victims in Rwanda and (...) Liberia, they have turned a blind eye to the major powers which have killedâ "on a much larger and more brutal scale, by comparisonâ "innocent civilians in Iraq and Afghanistan, just to cite two current examples. Contrary to the conventional wisdom conveniently held by many in human history, the rule of law has its other side which has not yet been systematically understood, such that the rule of law is neither possible nor desirable to the extent that the defenders of legal institutions in human history would like us to believe. Lest any misunderstanding hastily occur, this is not to imply that the rule of law is absolutely useless, or that the literature in jurisprudence (and other related fields like political philosophy, ethics, law and economics, and the sociology of law) should be dismissed because of its scholarly irrelevance. Of course, neither of these two extreme views is reasonable either. Instead, this book provides an alternative (better) way to understand the nature of law, in relation to its necessity and contingency in the context of justiceâ "while learning from different approaches in the literature but without favoring any one of them (nor integrating them, since they are not necessarily compatible with each other). In the process, this book offers a new theory to transcend the existing approaches in the literature in a new directionâ "in that, in the end, there is no justice without injustice and that it will be transcended too. This seminal project, if successful, will fundamentally change the way that we think about the nature of law, from the combined perspectives of the mind, nature, society, and culture, with enormous implications for the human future and what I originally called its â oepost-humanâ fate. (shrink)

Solidarity is a fundamental social value in many European countries, though its precise practical and theoretical meaning is disputed. In a health care context, I agree with European writers who take solidarity normatively to mean roughly equal access to effective health care for all. That is, solidarity includes a sense of justice. Given that, I will argue that precision medicine represents a potential weakening of solidarity, albeit not a unique weakening. Precision medicine includes 150 targeted cancer therapies (mostly for (...) metastatic cancer), all of which are extraordinarily expensive. Our critical question: Must a commitment to solidarity as defined mean that all these targeted cancer therapies should be guaranteed to all within each country in the European Union, no matter the cost, no matter the degree of effectiveness? Such a commitment would imply that cancer was ethically special, rightfully commandeering unlimited resources. That in itself would undermine solidarity. I offer multiple examples of how current and future dissemination of these targeted cancer drugs threaten a commitment to solidarity. An alternative is to fund more cancer prevention efforts. However, that too proves a threat to solidarity. Solidarity, with or without a sense of justice, is too abstract a notion to address these challenges. Further, we need to accept that we can only hope to achieve “rough justice” and “supple solidarity.” The precise practical meaning of these notions needs to be worked out through a fair and inclusive process of rational democratic deliberation, which is the real and practical foundation of just solidarity. (shrink)

For much of 2021, allocating the scarce supply of Covid‐19 vaccines was the world's most pressing bioethical challenge, and similar challenges may recur for novel therapies and future vaccines. In the United States, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) identified three fundamental ethical principles to guide the process: maximize benefits, promote justice, and mitigate health inequities. We argue that critical components of the recommended protocol were internally inconsistent with these principles. Specifically, (...) the ACIP violated its principles by recommending overly broad health care worker priority in phase 1a, using being at least seventy‐five years of age as the only criterion to identify individuals at high risk of death from Covid‐19 during phase 1b, failing to recommend place‐based vaccine distribution, and implicitly endorsing first‐come, first‐served allocation. More rigorous empirical work and the development of a complete ethical framework that recognizes trade‐offs between principles may have prevented these mistakes and saved lives. (shrink)

Artificial Intelligence (AI) is predicted to have a deep impact on the future of work and employment. The paper outlines a normative framework to understand and protect human freedom and justice in this transition. The proposed framework is based on four main ideas: going beyond the idea of a Basic Income to compensate the losers in the transition towards AI-driven work, towards a Responsible Innovation approach, in which the development of AI technologies is governed by an inclusive and (...) deliberate societal judgment; going beyond a philosophical conceptualisation of social justice only focused on the distribution of ‘primary goods’, towards one focused on the different goals, values, and virtues of various social practices (Walzer’s ‘spheres of justice’) and the different individual capabilities of persons (Sen’s ‘capabilities’); going beyond a classical understanding of capital, towards one explicitly including mental capacities as a source of value for AI-driven activities. In an effort to promote an interdisciplinary approach, the paper combines political and economic theories of freedom, justice and capital with recent approaches in applied ethics of technology, and starts applying its normative framework to some concrete example of AI-based systems: healthcare robotics, ‘citizen science’, social media and platform economy. (shrink)