Bioethics In Social Context

Bioethics In Social Context

Edited by Barry Hoffmaster
Copyright Date: 2001
Published by: Temple University Press
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  • Book Info
    Bioethics In Social Context
    Book Description:

    The problems of bioethics are embedded in people's lives and social worlds. They are shaped by individual biographies and relationships, by the ethos and institutions of health care, by economic and political pressures, by media depictions, and by the assumptions, beliefs, and values that permeate cultures and times. Yet these forces are largely ignored by a professional bioethics that concentrates on the theoretical justification of decisions.The original essays in this volume use qualitative research methods to expose the multiple contexts within which the problems of bioethics arise, are defined and debated, and ultimately resolved. In a provocative concluding essay, one contributor asks his fellow ethnographers to reflect on the ethical problems of ethnography.

    eISBN: 978-1-4399-0116-8
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Acknowledgments
    (pp. vii-ix)
  4. Introduction
    (pp. 1-11)
    Barry Hoffmaster

    Bioethics has been preoccupied with making judgments about troublesome moral problems and justifying those judgments, with doing what has been aptly called “quandary ethics.”¹ Following the lead of philosophical ethics, justification is regarded as a matter of providing “good reasons” for judgments, and that, in turn, is taken to require an appeal to moral rules or principles or to moral theories. Bioethics, in this view, is situated in rationality and generality. It prescinds the messy details and attachments that give our lives meaning and vigor, the nagging contradictions that make us squirm and struggle, and the social, political, and economic...

  5. 1 Clinical Narratives and Ethical Dilemmas in Geriatrics
    (pp. 12-38)
    Sharon R. Kaufman

    By now the critique of traditional bioethics, based on tenets of Western philosophical rationalist thought (Marshall 1992), is well known in the medical social sciences. Clinicians and others have commented on the remoteness or ineffectiveness of moral theory for actual problem solving (Anspach 1993; Hoffmaster 1992, 1994; Smith and Churchill 1986). Social scientists have noted the lack of attention to culture, ethnicity, and economics in North American bioethics and the primacy it grants individualism and self-determination as these notions have emerged in the Western (predominantly Anglo-American) industrialized world (Fox 1991; Kleinman 1995; Marshall 1992).

    Ethnographers studying physician training (Bosk 1979;...

  6. 2 Situated Ethics, Culture, and the Brain Death “Problem” in Japan
    (pp. 39-68)
    Margaret Lock

    Anthropologists are trained to be inherently skeptical of generalizations—to be alert to boundaries, margins, and differences. Most, but not all, of us are “splitters” in Tambiah’s idiom (1990); that is, we seek to relativize information by situating it in context. Moreover, to the majority of anthropologists, contextualization intuitively means the situation of knowledge in “cultural” context. But for many thoughtful anthropologists today, the problem of contextualization cannot be dealt with unless two issues are confronted head-on: (1) What do wemeanby culture, and does this continue to be a useful category? (Similar questions arise with respect to history.)...

  7. 3 Constructing Moral Boundaries: Public Discourse on Human Experimentation in Twentieth-Century America
    (pp. 69-89)
    Sydney A. Halpern

    During the 1960s and 1970s, the treatment of human subjects in clinical research became an identified public problem. Medical journals published commentaries criticizing researchers for moral laxity. Newspapers carried stories of investigatory abuse. Congress convened hearings on questionable experimental practices, including exposing subjects to great risk without the possibility of benefit, drawing subjects from vulnerable—often institutionalized—groups, and failing to secure informed consent. Scholars in the newly consolidating field of bioethics articulated principles to guide investigatory conduct. Their standards enjoined researchers to avoid protocols involving undue risk, cease recruiting subjects from vulnerable groups, and obtain consent that is both...

  8. 4 Media Images, Genetics, and Culture: Potential Impacts of Reporting Scientific Findings on Bioethics
    (pp. 90-111)
    Peter Conrad

    Bioethical issues generally are conceived of as arising within doctor-patient encounters and relating to matters such as the provision of medical information, decisions about treatment protocols, and the scientific investigation of treatment options. The vision of bioethics has focused largely on decision making, autonomy, and consent in treatment and research contexts. In this chapter, I want to broaden the scope of bioethics to include aspects of the social context that typically are not considered as “bioethical” concerns. Specifically, I will focus on how genetic findings are reported in the news and outline some implications for bioethics.

    This chapter stems from...

  9. 5 Emotions in Medical and Moral Life
    (pp. 112-136)
    Renee R. Anspach and Diane Beeson

    Both medical life and moral life evoke deep emotions. Merely contemplating a hospital conjures emotion-laden images: the grief of families of dying patients; the joy of new parents; the fear of patients hearing a diagnosis of cancer; the pride of a surgeon describing a technical feat; and the guilt of a medical student experiencing the first death of a patient. Moral life, too, evokes emotionally charged imagery: the vehemence of Dr. Jack Kevorkian as well as that of his opponents; the anger of demonstrators outside an abortion clinic; the anguish of a doctor on trial for having disconnected his own...

  10. 6 A Contextual Approach to Clinical Ethics Consultation
    (pp. 137-152)
    Patricia A. Marshall

    Clinical ethics consultation has become increasingly prevalent in biomedical settings in the last decade. A recent consensus statement (Fletcher and Siegler 1996:125) defined ethics consultation as “a service provided by an individual consultant, team, or committee to address the ethical issues involved in a specific clinical case.” The primary goal of ethics consultation is to improve patient care by helping patients, their families, and health care providers to identify, analyze, and resolve ethical problems that occur in the course of medical treatment.¹ Central to achieving the objectives of ethics consultations are the implementation of fair and accessible decision-making processes and...

  11. 7 Family Values and Resistance to Genetic Testing
    (pp. 153-179)
    Diane Beeson and Teresa Doksum

    We are currently in the midst of a historic shift in the conceptualization of health and illness. Increasingly health and illness are being viewed through “the prism of heritability” (Duster 1990:2). The seductiveness of this perspective is reflected in the proliferation of terms such as “geneticization,” “the genetic revolution” (Elmer-DeWitt 1994; Kitcher 1996), and “genomania” (Hubbard 1995:13). Lippman (1991:19) defined “geneticization” as “the process by which interventions employing genetic technologies are adopted to manage problems of health.” She sees geneticization as displacing other narratives as it becomes the dominant approach to managing a whole host of disorders and disabilities. Regardless...

  12. 8 Ethics Committees and Social Change: Plus ça Change?
    (pp. 180-198)
    Cate McBurney

    One of the most fertile sites for contextual analysis of health care ethics is located at its core—the operation of the institutional ethics committee (IEC). IECs have been contextual entities from their inception. They are the result of powerful social forces, and they represent both a response to social change and an attempt to foster further change.

    In its 1983 report,Deciding to Forego Life-Sustaining Treatment, the President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research recommends four roles for IECs: (a) confirming diagnosis and prognosis; (b) reviewing treatment decisions made by physicians,...

  13. Irony, Ethnography, and Informed Consent
    (pp. 199-220)
    Charles L. Bosk

    Much of this volume is an argument for and demonstration of two interrelated propositions: Bioethical analysis can be made sharper if more attention is paid to the context of medical decision making, and ethnography is the ideal method for accomplishing this. Intellectual completeness and honesty—not to mention the self-reflexive dimension of ethnographic work itself—require that attention to the ethnography of medical ethics be matched by a reciprocal analysis of the ethics of ethnography.

    That is the task of this chapter. In it, I first discuss some of the standard ethical dilemmas fieldworkers recognize as inherent in ethnographic methods....

  14. Afterword
    (pp. 221-228)
    Barry Hoffmaster

    Many of the chapters in this volume employ qualitative research methods. Indeed, the use of such methods, ethnography in particular, seems to be central to creating the kind of contextual approach to bioethics that this volume seeks (see Conrad 1994; Hoffmaster 1992; Jennings 1990). That view has become almost commonplace, for as Fox and DeVries have observed, “Among sociologists working in the field of bioethics, it is taken for granted that the method par excellence of conducting socially and culturally cognizant and sensitive bioethical research is ethnography” (1998:273).

    Bosk’s list of ethnography’s moral violations should, however, chasten those who advocate...

  15. About the Contributors
    (pp. 229-230)
  16. Index
    (pp. 231-234)