The future of bioethics: Three dogmas and a cup of hemlock

Bioethics

Volumn 24, Issue 5, 2010, Pages 218-225

  Dawson, Angus ^a  

^a KEELE UNIVERSITY   (United Kingdom)

Author keywords

Bioethics; Dogmas; Ideology; Medical ethics; Public health ethics

Indexed keywords

ARTICLE; BIOETHICS; CONFLICT; ETHICS; FORECASTING; HUMAN; HUMAN RELATION; MEDICAL ETHICS; MORALITY; PERSONAL AUTONOMY; PHILOSOPHY; PROFESSIONAL PRACTICE; PUBLIC HEALTH; TRENDS;

BIOETHICS; DISSENT AND DISPUTES; ETHICS, MEDICAL; FORECASTING; HUMANS; MORAL OBLIGATIONS; PERSONAL AUTONOMY; PHILOSOPHY; PROFESSIONAL AUTONOMY; PROFESSIONAL-PATIENT RELATIONS; PUBLIC HEALTH;

EID: 77955047121     PISSN: 02699702     EISSN: 14678519     Source Type: Journal    
DOI: 10.1111/j.1467-8519.2010.01814.x     Document Type: Article

References (33)

1. This takes the prefix 'bio-' to mean 'life'. This, of course, doesn't mean that bioethics covers everything that is alive (as it would then include all applied ethics, including ethical issues that I do not see as being part of bioethics - e.g. police ethics, social work ethics, etc.).
2. H. Kuhse & P. Singer, eds. 2006. Bioethics: An Anthology (2nd edn). Oxford: Blackwell. This is not the place for a full-scale review of the history of bioethics, but it is interesting to note that these two issues come together in the editorial in the first issue of the journal Bioethics, where bioethics is defined by Kuhse and Singer as 'ethical issues raised by medicine and the biological sciences'. See H. Kuhse & P. Singer. 1987. Bioethics: What? And Why? Bioethics; 1(1): iii-v
3. The examples of possible topics that they cite as a guide to journal content does not include anything in public health, mental health or to do with animals (but we can presume they are to be construed as covered). They are rather dismissive of environmental issues, despite the fact that these are clearly related to health (just as aspects of agriculture, food production, and global inequities will be too).
4. Just in case the reader think that my focus is too narrow here, Gert et al. similarly use 'bioethics' as a synonym for 'medical ethics'. See B. Gert, C.M. Culver & K.D. Clouser. 2006. Bioethics: A Systematic Approach (2nd edn). Oxford: Oxford University Press. Holland accepts a wider definition of 'bioethics', but then chooses to restrict his discussion to a few keys topics in medicine, noting that that is how people 'tend to' use the term: S. Holland. 2003. Bioethics: A Philosophical Introduction. Cambridge: Polity.
5. Applied ethics is different again. It is even broader than bioethics in subject matter (including issues such as the justifications for violence and war; discussions of what racism is and how to respond to it in public policy, business ethics etc.) and it may also be more explicitly concerned with methodology (in terms of whether to literally apply a theory or not etc).
6. For more on the early history of bioethics (from a US perspective), see A.R. Jonson. 1998. The Birth of Bioethics. Oxford: Oxford University Press.
7. Despite this there are few real attempts to explicitly defend such a view. One of the best is T. May. 2002. Bioethics in a Liberal Society: The Political Framework of Bioethics Decision Making. Baltimore: Johns Hopkins University Press.
8. A. Dawson & A. Wrigley. A Dead Proposal: Levi and Green on Advance Directives. Am J Bioeth 2010; forthcoming.
9. 'The object of this Essay is to assert one very simple principle, as entitled to govern absolutely the dealings of society with the individual in the way of compulsion and control, whether the means used be physical force in the form of legal penalties, or the moral coercion of public opinion. That principle is, that the sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number, is self-protection. That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others...'. J. S. Mill. (1859) On Liberty (many editions).
10. A. Dawson & M. Verweij. The Steward of the Millian State. Public Health Ethics 2008; 1(3): 1-3.
11. B. Jennings. Public Health and Liberty: Beyond the Millian Paradigm. Public Health Ethics 2009; 2: 123-134.
12. O. O'Neill. Autonomy: The Emperor's New Clothes. Aristotelian Society, Supplementary Vol. LXXVII. 2003;: 1-21.
13. D. Resnik. Trimming the fat? Trans Fat Bans and Limitations Upon Human Freedoms. Am J Bioeth 2010; forthcoming.
14. J. Wilson & A. Dawson. Giving Liberty Its Due, But No More: Trans Fats, Liberty and Public Health. Am J Bioeth 2010; forthcoming.
15. S.J.L. Edwards, S. Kirchin & R. Huxtable. Research Ethics Committees and Paternalism. J Med Ethics 2004; 30: 88-91.
16. E. Garrard & A. Dawson. What is the Role of the REC? Paternalism, Inducements and Harm in Research Ethics. J Med Ethics 2005; 31: 419-423.
17. Of course, it may be objected that this consensus exists because they are right and I am wrong, and autonomy is in fact dominant (in the relevant sense). However, I doubt that many people really believe this implausible claim (for both theoretical and practical reasons).
18. T. Beauchamp & J. Childress. 2009. Principles of Biomedical Ethics (6th edn). Oxford: Oxford University Press.
19. R. Gillon. Ethics Needs Principles - Four can Encompass the Rest - and Respect for Autonomy should be 'First among Equals'. J Med Ethics 2003; 29: 307-312.
20. A. Dawson & E. Garrard. In Defence of Moral Imperialism: Four Equal and Universal Prima Facie Duties. J Med Ethics 2006; 32(4): 200-204.
21. For a good example of this minimal consumerist approach to professional obligations, see H. Malm et al. Ethics, Pandemics, and the Duty to Treat. Am J Bioeth 2008; 8(8). In my view, this model for how we should conceptualize social relations, or conceptualize our obligations, within the doctor-patient relationship is dreadfully mistaken A. Dawson. (forthcoming) Civic, Professional and Personal Obligations in Public Health Emergency Planning and Response. Morbidity and Mortality Weekly Report.
22. Of course others, particularly in feminist bioethics, have argued similar things. I admire the focus on relationships, the social and the political in work such as that of Sherwin. See: S. Sherwin. Whither Bioethics? How Feminism Can Help Reorient Bioethics. Int J Fem Approaches Bioeth 2008; 1(1): 7-27
23. However, I remain sceptical about the idea of 'relational autonomy', see C. Mackenzie & N. Soljar. 2000. Relational Autonomy: Feminist Perspectives on Autonomy, Agency, and the Social Self. Oxford: Oxford University Press, as it is too tempting to read this approach as a request for a mere modification to how we think of autonomy, but still leaving it at the centre of medical ethics (and hence bioethics). I think we need a more radical approach than this suggests.
24. A. Dawson. 2009. Theory and Practice in Public Health Ethics: a Complex Relationship. In Public Health Ethics & Practice. S. Peckham & A. Hann, eds. London: Policy Press: 191-209.
25. Resnik, op. cit. note 12.
26. J. Coggon. Public Health, Responsibility and English law: Are There Such Things as no Smoke without Ire or Needless Clean Needles? Med Law Rev 2009; 17: 127-139.
27. S. Bonner et al. Are Advance Directives Legally Binding or Simply the Starting Point for Discussion on Patients' Best Interests? Br Med J 2009; 339: 1230-1234.
28. Dawson & Wrigley, op. cit. note 7.
29. There is also the interesting issue of the role of academic lawyers promoting their own ethical views through appeal to the law in such cases.
30. N.C. Manson & O. O'Neill. 2007. Rethinking Informed Consent in Bioethics. Cambridge: Cambridge University Press.
31. M. Verweij & A. Dawson. 20007. The Meaning of 'Public' in 'Public Health'. In Ethics, Prevention and Public Health. A. Dawson & M. Verweij, eds. Oxford: Oxford University Press.
32. I say more about some of these issues in Dawson, op. cit. note 22; and A. Dawson. (forthcoming) Resetting the Parameters: Public Health as the Foundation for Public Health Ethics. In Public Health Ethics: Key Concepts and Issues in Policy and Practice. A. Dawson, ed. Cambridge: Cambridge University Press.
33. N. Mulvaney-Day & C.A. Womack. Obesity, Identity and Community: Leveraging Social Networks for Behavior Change in Public Health. Public Health Ethics 2009; 2(3): 250-260.