American Bioethics

​The goal of this open access book is to develop an approach to clinical health care ethics that is more accessible to, and usable by, health professionals than the now-dominant approaches that focus, for example, on the application of ethical principles. The book elaborates the view that health professionals have the emotional and intellectual resources to discuss and address ethical issues in clinical health care without needing to rely on the expertise of bioethicists. The early chapters review the history of bioethics and explain how academics from outside health care came to dominate the field of health care ethics, both in professional schools and in clinical health care. The middle chapters elaborate a series of concepts, drawn from philosophy and the social sciences, that set the stage for developing a framework that builds upon the individual moral experience of health professionals, that explains the discontinuities between the demands of bioethics and the experience and perceptions of health professionals, and that enables the articulation of a full theory of clinical ethics with clinicians themselves as the foundation. Against that background, the first of three chapters on professional education presents a general framework for teaching clinical ethics; the second discusses how to integrate ethics into formal health care curricula; and the third addresses the opportunities for teaching available in clinical settings. The final chapter, "Empowering Clinicians", brings together the various dimensions of the argument and anticipates potential questions about the framework developed in earlier chapters.

Medical or hio- ethics has in recent years been a growth industry. Journals, Centers and Associations devoted to the subject proliferate. Medical schools seem increasingly to be filling rare positions in the humanities and social sciences with ethicists. Hardly a day passes without some media scrutiny of one or another ethical dilemma resulting from our new-found ability to transform the natural conditions of life. Although bioethics is a self-consciously interdisciplinary field, it has not attracted the collaboration of many social scientists. In fact, social scientists who specialize in the study of medicine have in many cases watched its development with a certain ambivalence. No one disputes the significance and often the painfulness of the issues and choices being addressed. But there is something about the way these issues are usually handled which seems somehow inappropri ate if not wrong-headed to one trained in a discipline like sociology or history. In their analyses of complex situations, ethicists often appear grandly oblivious to the social and cultural context in which these occur, and indeed to empirical referents of any sort. Nor do they seem very conscious of the cultural specificity of many of the values and procedures they utilize when making ethical judg ments. The unease felt by many in the social sciences was given articulate expression in a paper by Renee Fox and Judith Swazey which appeared in 1984.

This book presents a unique view of the current state of development of bioethics in Latin America. Twelve Latin American thinkers who share a primary interest in bioethics address a vast range of questions, including autonomy, rights, justice, and the role of culture and religion in bioethics. These studies contribute to an understanding of Latin American thought, and they make possible a transcultural dialogue on bioethical issues.

In Bioethics in America, Tina Stevens challenges the view that the origins of the bioethics movement can be found in the 1960s, a decade mounting challenges to all variety of authority. Instead, Stevens sees bioethics as one more product of a "centuries-long cultural legacy of American ambivalence toward progress," and she finds its modern roots in the responsible science movement that emerged following detonation of the atomic bomb. Rather than challenging authority, she says, the bioethics movement was an aid to authority, in that it allowed medical doctors and researchers to proceed on course while bioethicists managed public fears about medicine's new technologies. That is, the public was reassured by bioethical oversight of biomedicine; in reality, however, bioethicists belonged to the same mainstream that produced the doctors and researchers whom the bioethicists were guiding.

NOW FEATURING A NEW AFTERWORD, "PANDEMIC ETHICS" From two eminent scholars comes a provocative examination of bioethics and our culture’s obsession with having it all without paying the price. Shockingly, the United States has among the lowest life expectancies and highest infant mortality rates of any high-income nation, yet, as Amy Gutmann and Jonathan D. Moreno show, we spend twice as much per capita on medical care without insuring everyone. A “remarkable, highly readable journey” (Judy Woodruff ) sure to become a classic on bioethics, Everybody Wants to Go to Heaven but Nobody Wants to Die explores the troubling contradictions between expanding medical research and neglecting human rights, from testing anthrax vaccines on children to using brain science for marketing campaigns. Providing “a clear and compassionate presentation” (Library Journal) of such complex topics as radical changes in doctor-patient relations, legal controversies over in vitro babies, experiments on humans, unaffordable new drugs, and limited access to hospice care, this urgent and incisive history is “required reading for anyone with a heartbeat” (Andrea Mitchell).

Bioethics was "born in the USA" and the values American bioethics embrace are based on American law, including liberty and justice. This book crosses the borders between bioethics and law, but moves beyond the domestic law/bioethics struggles for dominance by exploring attempts to articulate universal principles based on international human rights. The isolationism of bioethics in the US is not tenable in the wake of scientific triumphs like decoding the human genome, and civilizational tragedies like international terrorism. Annas argues that by crossing boundaries which have artificially separated bioethics and health law from the international human rights movement, American bioethics can be reborn as a global force for good, instead of serving mainly the purposes of U.S. academics. This thesis is explored in a variety of international contexts such as terrorism and genetic engineering, and in U.S. domestic disputes such as patient rights and market medicine. The citizens of the world have created two universal codes: science has sequenced the human genome and the United Nations has produced the Universal Declaration of Human Rights. The challenge for American bioethics is to combine these two great codes in imaginative and constructive ways to make the world a better, and healthier, place to live.

Catholic health care is one of the key places where the church lives Catholic social teaching (CST). Yet the individualistic methodology of Catholic bioethics inherited from the manualist tradition has yet to incorporate this critical component of the Catholic moral tradition. Informed by the places where Catholic health care intersects with the diverse societal injustices embodied in the patients it encounters, this book brings the lens of CST to bear on Catholic health care, illuminating a new spectrum of ethical issues and practical recommendations from social determinants of health, immigration, diversity and disparities, behavioral health, gender-questioning patients, and environmental and global health issues.

When his teenaged son Christopher, brain-damaged in an auto accident, developed a 106-degree fever following weeks of unconsciousness, John Campbell asked the attending physician for help. The doctor refused. Why bother? The boy's life was effectively over. Campbell refused to accept this verdict. He demanded treatment and threatened legal action. The doctor finally relented. With treatment, Christopher's temperature subsided almost immediately. Soon afterwards he regained consciousness and today he is learning to walk again. This story is one of many Wesley Smith recounts in his groundbreaking new book, The Culture of Death. Smith believes that American medicine ''is changing from a system based on the sanctity of human life into a starkly utilitarian model in which the medically defenseless are seen as having not just a 'right' but a 'duty' to die.'' Going behind the current scenes of our health care system, he shows how doctors withdraw desired care based on Futile Care Theory rather than provide it as required by the Hippocratic Oath. And how ''bioethicists'' influence policy by considering questions such as whether organs may be harvested from the terminally ill and disabled. This is a passionate, yet coolly reasoned book about the current crisis in medical ethics by an author who has made ''the new thanatology'' his consuming interest.

American law, not philosophy or medicine, is the major force shaping American bioethics. This is both because law at its best fosters individual rights, equality, and justice, and because violation of the legal duty or "standard of care" a physician owes a patient can lead to a malpractice suit. The law has therefore had two conflicting impacts on medical ethics: the positive effect of eroding paternalism and replacing it with a patient-centered ethic; and the negative effect of encouraging physicians to be more concerned with avoiding litigation than doing the "right" thing. Standard of Care explores the fundamental value conflicts confronting medicine and society by examining courtroom resolutions of real bioethical disputes, often of constitutional dimension. This case-based approach, which ranges from abortion to euthanasia, from AIDS to organ transplantation, from genetic research to the artificial heart and rationing, illuminates the value choices with which the power (and impotence) of medicine confronts us. George Annas urges health care professionals to go beyond the minimalist legal "standard of care" by promoting a vigorous, patient-centered medical ethics based on respect for human rights and responsibility to both patients and society. If modern medicine is to enhance human life, a reconceptualization of law as the beginning of ethical discourse, rather than as an instrument to end it, is essential. Such a discourse could enrich all our lives by helping us to articulate both a national and international agenda for human rights in health.