Society's Choices Social and Ethical Decision Making in Biomedicine (1995) / Chapter Skim
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2. The Social Context of Bioethical Problem Solving
2. The Social Context of Bioethical Problem Solving
Pages 43-66
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From page 43... ...
Our nation was born in rebellion against tyranny to preserve individual liberty; tension between the powers of the state and the rights of the individual has persisted, and it colors the public debate and resolution of major moral issues. In addition, our culture is suffused with an optimistic expectation of progress and change for the better, best exemplified in an unwavering belief in the myth of upward social mobility.
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From page 44... ...
Thus, intense debate at the local and state levels contributed to the formation and acceptance of a central governmental response. The capacities for public debate of ethical issues in our society have expanded and matured within the past few decades.
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From page 45... ...
health care are familiar with this theme. Ambivalence about government has been offered as an explanation for why Americans refused national health insurance long after the rest of the industrialized world had secured it.
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From page 46... ...
One answer lies in the recurring impulse to organize great democratic movements a populist urge to remake government, organize direct participation, foster a renewed sense of community. This "democratic wish" has been pursued in a wide variety of contexts across the generations: AntiFederalists resisting the Constitution, Jacksonians remaking the federal government, abolitionists redefining citizenship, New Left students seeking a more democratic society, and African American activists demanding civil rights.
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From page 47... ...
Religious organizations are not the only groups that have actively debated and responded to major moral issues, including those brought on by developments in biomedical technology; many other groups are notable for their participation in such debates. Moreover, in addition to the response of diverse social groups, institutions (e.g., the scientific research community and biotechnology industry)
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From page 48... ...
health establishment and further entrenched the African American community's distrust of medicine: the Tuskegee Syphilis Study (see Chapter 1) and the African American community's experience with sickle cell anemia screening programs.
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From page 49... ...
These programs were spurred in the early 1970s by a perception that the disease, more prevalent in African Americans than in others, had been neglected, and by a desire to remedy the racial inequities brought to light by the civil rights movement. However, screening programs were undertaken with little public education, little counseling for those identified as carriers, and insufficient attention to clarification of the distinction between sickle cell traits and sickle cell disease (Foss and Kaback, 1972~.
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From page 50... ...
As restrictions on reproductive freedom came to be seen as an issue of male domination over women's sexuality and autonomy, the movement expanded to encompass a broader challenge to the male-dominated medical profession's authority to dictate women's health in many other areas. With the first publication of Our Bodies, Ourselves by the Boston Women's Health Book Collective in
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From page 51... ...
Despite increasing numbers of women entering careers in medicine, women continue to be underrepresented in the medical profession, and some within it have observed an entrenched bias against women (Komaromy et al., 1993~. Women's health advocates were also instrumental in calling for the review and revision of existing NIH and FDA policies that routinely excluded women of childbearing age from research trials.
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From page 52... ...
The Stonewall riots in New York City in 1969, following a police raid on a gay bar in Greenwich Village, led to a decade of organizing, fundraising, and consciousness-raising among gays and lesbians throughout the country, modeled on the civil rights and feminist movements. The late 1970s saw renewed efforts in reaction to a backlash that resulted in the repeal of gay rights ordinances in Dade County, Florida, and other cities.
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From page 53... ...
Everett Koop notes in his 1991 autobiography that "the Reagan revolution brought into positions of power and influence Americans whose politics and personal beliefs predisposed them to antipathy toward the homosexual community." Conservative politics, Koop adds, both slowed the understanding of AIDS and thwarted his attempts to educate the public about the disease. In the face of an establishment that failed to rise to the challenge of the AIDS epidemic, gays began to organize their own community health clinics and treatment networks, seeking to redefine the notion of AIDS as a disease rather than divine retribution (Shilts, 1987; Padgug and Oppenheimer, 1992~.
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From page 54... ...
They are troubled by the apparent inability of the health care system to control spiraling costs for medical insurance and medical treatment, and wonder what type and level of basic research will provide relevant advances in medical care at an affordable cost to the public. In considering patients' relationships to the health care system, employment-based health benefits and the role of employers have to be taken into account.
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From page 55... ...
Like hospitals, they are actively engaged in setting up networks, buying hospitals, and establishing a variety of diagnostic and therapeutic facilities and thus may be a powerful part of any future health care system. Public discourse surrounding biomedical developments is affected not only by the activities of specific social groups, but also by the institutional landscape of hospitals, government and industrial research communities, and academic activities in bioethics.
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From page 56... ...
Between 1850 and 1920, the American hospital was transformed from an asylum for the indigent noisy, dirty, and in disarray to a scientifically oriented institution for medical management and nursing care. The dramatic change was prompted largely by a combination of industrialization, urbanization, and immigration, as well as by advances in sanitation and medical treatment (Rosenberg, 1987~.
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From page 57... ...
Drug companies are resorting to novel strategies in order to maintain prized relationships with physicians and hospitals while the restructuring is under way. A variety of influences is diminishing our society's traditional reliance on hospitals as independent entities: · increased dissatisfaction of the public and of major political figures with the high cost of health care and the major role played by hospitals and their administrative costs in the genesis of this difficult burden; · growing ability of and financial incentive for outpatient care to substitute for in-hospital care due to advances in medical management and technology (e.g., cardiac catheterization, renal dialysis)
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From page 58... ...
Inpatient and outpatient hospital care comprised 43.7 percent of the total personal health care expenditures, but only 3.4 percent of this was paid directly by the patient, while private health insurance paid for 35.2 percent and public health insurance paid for 56.3 percent of the charges. Another $23.1 billion was spent on biomedical research and development, about half of it in federal funds.
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From page 59... ...
By 1993, 21 approved drugs or vaccines and over 600 diagnostic agents had reached the market; another 16 agents are awaiting FDA approval, and 132 agents are in clinical trials. The biotechnology industry is predicted to grow to a $50 billion industry by the year 2000 (President's Council on Competitiveness, 1991~.
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From page 60... ...
Industry also looks to the academic research community for new skills and techniques, specific assays and reagents, personnel to conduct clinical trials, consultants and collaborators, individuals to provide expertise to regulatory agencies, and highly skilled scientists and technicians to work in industry. To facilitate cooperation between academia and industry, value questions related to ownership of intellectual property rights and conflicts of interest must be resolved.
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From page 61... ...
He notes that technologic progress depends not only on new science and technology but also on cultural and social factors such as political stability, life expectancy, nutrition, attitudes toward risk, natural resources, property rights, religious values, demographics, and openness to change. The critical contributions from the university sector are education and advanced training, quasi-independent scientific agendas, and exploration of the human condition, through a broad set of historical, cultural, political, and value questions.
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From page 62... ...
A 1990 survey by the National Science Board showed that most Americans trust the motives of scientists; 80 percent of respondents agreed that most scientists want to make life better for the average person (National Science Board, 1991~. The survey also showed that between 1979 and 1990, decreasing proportions of respondents agreed with the statement that "Science makes our way of life change too fast." Most respondents indicated that they believe that the benefits of scientific research had outweighed the harmful results; a majority perceived a strong link between advances in science and technology and improvements in their own daily lives.
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From page 63... ...
As head of the NIH Office of Genome Research (now the Nanona1 Center for Human Genome Research) , he responded to public and congressional concern by proposing to use part of the money allocated to the Human Genome Project to study the ethical, social, and legal issues that are raised by the information this research generates.
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From page 64... ...
Berkeley: University of California Press. Biotechnology Industry Organization (BIO)
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From page 65... ...
Boston: Northeastern University Press. Pharmaceutical Manufacturers Association (PMA)
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From page 66... ...
D.C. Pharmaceutical Manufacturers Association.
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