Theoretical Medicine and Bioethics最新文献

Since the advent of drug regulation in 1962, regulatory agencies have been in the practice of using strict standards to test the safety and efficacy of medical treatments and products. Regulatory agencies, such as the FDA, demand two full-fledged Randomized Clinical Trials demonstrating the safety and effectiveness of drugs to grant its marketing authorization. On the contrary, surgical treatments are left completely unregulated. There are several reasons explaining this difference, and all of them point to the difficulty of conducting well-designed RCTs in surgery. However, we argue that none of these arguments is decisive and that, under certain conditions, surgical RCTs can be morally justified and methodologically sound. Although ethical constraints restrict the number of testable surgical procedures, and surgical trials might not be as dependable as pharmaceutical RCTs, our analysis suggests that, in certain cases, it is possible to obtain high-quality evidence about the safety and efficacy of surgical procedures. Untested surgical treatments may prove to be ineffective and harm patients. Therefore, regulation of surgical procedures seems not only morally acceptable and able to provide reliable scientific evidence, but also desirable and justified from an ethical-political standpoint.

The ongoing debate about moral bioenhancement (MBE) has been exceptionally stimulating, but it is defined by extreme polarization and lack of consensus about any relevant aspect of MBE. This article reviews the discussion on MBE, showing that a lack of consensus about enhancements' desirable features and the constant development of the debate calls for a more rigorous ethical analysis. I identify a list of factors that may be of crucial importance for illuminating the matters of moral permissibility in the MBE debate and which could help us move beyond the current lack of consensus. More precisely, I propose three important theoretical and normative standards that MBE should satisfy if we wish to mitigate the concerns about its utter impermissibility. Systematically assessing MBE interventions across the presented categories should provide valuable conclusions about its theoretical soundness and feasibility, its compatibility with fundamental moral norms, and its compatibility with or facilitation of socio-political goals of equality and justice.

This essay presents a challenge to the parental obligation objection. This objection is usually made by abortion opponents who argue that because child support laws hold men postnatally responsible for children they helped bring into existence (even when they did not intend to become parents), women too have prenatal parental responsibilities that should prevent them from ending pregnancies through abortions. My essay draws on recent publications in bioethics that distinguish procreative from parental responsibilities. This distinction was originally developed to clarify the duties of third-party participants in assisted reproduction. However, the distinction inadvertently poses a problem for the parental obligation objection, for it raises questions about whether women who do not wish to carry a child to term have parental rather than procreative responsibilities. It does not necessarily follow that the objection must be wrong. But rather, that there is an explanatory gap in it. If abortion violates procreative responsibilities, then drastic changes must be made to fertility medicine. Conversely, there does not appear to be non-question-begging criteria that would explain why pregnant women must have parental responsibilities, in addition to procreative ones, whereas third-party participants in assisted reproduction, such as fertility doctors, embryologists, gamete donors, and surrogates, have only procreative responsibilities.

The national standards for clinical ethics consultation set forth by the American Society for Bioethics and Humanities (ASBH) endorse an “ethics facilitation” approach, which characterizes the role of the ethicist as one skilled at facilitating consensus within the range of ethically acceptable options. To determine the range of ethically acceptable options, ASBH recommends the standard model of decision-making (informed consent, advance directives, surrogates, best interests), which is grounded in the values of autonomy, beneficence, nonmaleficence, and justice. H. Tristram Engelhardt Jr. has sharply criticized the standard model for presuming contentful moral claims in circumscribing the range of ethically acceptable options, which, he argues, cannot be rationally justified in a pluralistic context. Engelhardt’s solution is a secular clinical ethics based on a contentless principle of permission. The first part of this article lays out Engelhardt’s negative claim, that reason cannot establish contentful moral claims, and his positive claim, that secular clinical ethics ought to be based on a contentless principle of permission. The second part critiques these negative and positive claims. The purpose of this paper is to defend secular clinical ethics expertise—defined as the ability of ethicists to offer justified moral recommendations grounded in consensus positions endorsed by the American Society for Bioethics and Humanities—from the radical critiques of Engelhardt, who argues that no moral or metaphysical claims, and hence no bioethical consensus, can be rationally justified. Engelhardt’s critiques have caused some to worry that secular clinical ethics is in a state of theoretical crisis; this article concludes that Engelhardt’s view is an unstable basis for that worry.

One must technologize bodies to conceive of organ transplantation. Organs must be envisioned as replaceable parts, serving mechanical functions for the workings of the body. In this way, it becomes possible to imagine exchanging someone’s organs without changing anything essential about the selfhood of the person. But to envision organs as mechanical parts is phenomenologically uncomfortable; thus, the terminology used to describe the practice of organ retrieval seems to attempt other, less technological ways of viewing the human body. In this paper, I analyze three common metaphors that currently contextualize the process of organ retrieval in English-speaking communities: harvesting the agrarian body, procuring the commodified body, and receiving the gifted body. These powerful images constrain the gaze toward the body in important ways. Every gaze both obscures and reveals. While each of these three metaphors makes sense of some aspects of organ retrieval, each of them is ultimately subject to being overtaken by what Jeffrey Bishop calls the technological imaginary. This imaginary deploys a gaze that obscures important elements of what it means to be human and does violence to parts of the phenomenological experience of transplantation and bodily existence. I argue that no matter how hard one tries to avoid the technological aspect of transplantation practices by embracing nonviolent metaphors—even the metaphor of gifting, which seems the most promising—it will never be possible to fully resist organ transplantation’s violence toward our phenomenological sense of embodiment.

There are increasing calls to reject the dead-donor rule and permit organ donation euthanasia in organ transplantation. I argue that the fundamental problem with this proposal is that it would bestow more worth on the organs than on the donor who possesses them. What is at stake is the basis of human equality, which, I argue, should be based on an ineliminable dignity that each of us has in virtue of having a rational nature. To allow mortal harvesting would be to make our worth contingent upon variable quality-of-life judgments that can be based only on properties that come in degrees. Thus, rejecting the dead-donor rule comes at the expense of egalitarian principles with respect to the value each individual human life has in relation to the protections against killing.