Society's Choices Social and Ethical Decision Making in Biomedicine (1995) / Chapter Skim
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3. Systematic Approaches to Bioethics
3. Systematic Approaches to Bioethics
Pages 67-86
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From page 67... ...
, courses, conferences, and journals. What contribution can academic bioethics make toward public moral discourse about the biomedical sciences and health care practices and policies?
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From page 68... ...
What then is the proportionate contribution of academic bioethics, in relation to professional and popular bioethics, and indeed in relation to other forms of discourse in a democratic society, such as legal, economic, political, and religious? The primary task of any public body charged with providing a forum for public moral discourse is to orchestrate these various perspectives.
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From page 69... ...
In the United States, theologians James Gustafson and Leroy Augenstein and philosophers Hans Jonas and Martin Golding published reflective commentaries on similar themes. These, however, were occasional essays, raising questions and testing approaches, rather than subjecting the world of biomedical science and practice to focused moral analysis.
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From page 70... ...
R.M. Hare, one of the most prominent moral philosophers of the era, was asked to speak to the topic: Can the moral philosopher help in doing philosophical medical ethics?
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From page 71... ...
This is not to claim that all moral philosophers employed Firth's Ideal Observer theory, or its variants, in the solution of moral problems. Rather, the theory implies that if public moral discourse is composed of popular moral concern and professional moral pronouncements, as suggested above, then the moral philosopher should approach the problem with an attitude that can correct the defects of both of these contributions.
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From page 72... ...
These are significant virtues in public moral discourse, which is often highly particularist. The moral philosophers of the 1960s were pulled out of their concern with the speculative questions of moral judgment into the world of practical concern over the rights and wrongs of such burning questions as civil rights and the justification of the war in Southeast Asia.
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From page 73... ...
It was never made clear how all these facts fitted into a coherent philosophical argument (President's Commission, 1982~. Currently, bioethics scholars are debating vigorously the relationship between principles and facts, a debate that is essential to the role of academic bioethics in public moral discourse.
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From page 74... ...
Several centers of theological and religious reflection on bioethics exist with church sponsorship, among them The Park Ridge Center for the Study of Health, Faith, and Ethics, supported by the Lutheran Hospital Association; the Loma Linda Center for Christian Bioethics, affiliated with the Seventh Day Adventist Church; and the Pope John XII Medico-Moral Research Center, operated under Catholic auspices. A research center that focuses on religious and theological aspects of the Human Genome Project has been funded by the ELSI program at the Graduate Theological Union in Berkeley.
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From page 75... ...
If anything, individual virtue and mutual trust have historically been preconditions for the production of scientific "truths" that are acknowledged as such within a community of researchers. Apart from questionable claims about scientists' special virtue, there are three additional grounds that might be advanced for why scientists should be accorded a privileged place in ethical decision making: · First, science, because of its openness and critical tradition, can be thought to provide a particularly appropriate discursive model for making ethical decisions in a pluralist society.
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From page 76... ...
It may not be farfetched to argue that our public moral discourse is uniquely shaped by the confluence of scientific and legal noes of criticism. Science has supplied the authoritative model for determining what kinds of arguments may be advanced in public life, whereas the law has deeply influenced our thinking about who should be allowed to make these arguments and through what procedures.
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From page 77... ...
Disqualification on grounds of intellectual bias may be the best way to describe the "voluntary" withdrawal of a member of the NAS committee on DNA fingerprinting who was felt to have inappropriately close ties to the biotechnology industry (Roberts, 1992~. The values of wide representation and technically grounded rationality are most likely to conflict in forums that employ overly formal processes of criticism.
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From page 78... ...
Participation in public moral discourse may help them to make their value commitments explicit, and then integrate these
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From page 79... ...
Examples such as this suggest that, in order to play an effective part in public moral discourse, scientists may first need to develop a more reflective understanding of the ways in which they do science. Facts and Values Social and political institutions continue in hard cases to delegate to science the power to make binding ethical judgments.
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From page 80... ...
Yet for scientists to play their ethical part most effectively, they need to be involved in forums that open up their perspectives and underlying assumptions to critical evaluation. Scientific advice will tend to be least ethically sensitive when it is offered as unexamined "fact." It may advance social decisions most in a context that forces scientists to become aware of their own value commitments.
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From page 81... ...
The Society for Health and Human Values, founded in 1968, established a program through which consultations were provided to medical schools interested in initiating courses aimed at exploring the ethical and human values dimensions of the health care enterprise. Throughout the following decade, faculty trained in the humanities began to appear in gradually increasing numbers on medical school faculties.
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From page 82... ...
Medical students may experience these effects when they confront human suffering without sufficient mentoring, on exhausting schedules, and in the face of the scientific determinism and reductionism that characterizes molecular biology. Fox suggested several strategies for making medical education and, ultimately, medical care, more humanistic: · more awareness of how biomedicine is imprinted with dichotomies that split competence from caring; · more attention to the cognitive content of medicine; · more attention to the defense mechanisms developed during training and their implications for humane competence; and · more effort to ensuring felicitous timing for training experiences; · a return by teachers to firsthand teaching.
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From page 83... ...
· To understand the relationship between ill health and the social context of disease (Tarlov, 1992; Maheux et al., 1990~. A 1987 AAMC survey of the medical ethics curricula, "Integrating Human Values Teaching Programs Into Medical Students' Clinical Education," examined 113 course descriptions from the 1989~1985 school year and 99 completed surveys from the 126 medical schools contacted.
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From page 84... ...
supports the idea that moral reasoning ability is facilitated by exposing individuals to dilemmas that challenge one's current level of moral reasoning skills. Other studies reveal that moral development continues throughout formal educai~on and can be dramatic in early adulthood (the time of professional trainings, and that well~eveloped educational interventions can enhance ethical consciousness and commitment (Rest, 1988; Blasi, 1980; Josephson, 1988; Leming, 1981~.
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From page 85... ...
1985. Basic curricular goals in medical ethics.
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From page 86... ...
1984. Physicians for the twenty-first century: Report of the Project Panel on the General Professional Education of the Physician and College Preparation for Medicine.
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