MORAL EXPERTISE: A PROBLEM IN THE PROFESSIONAL ETHICS OF PROFESSIONAL ETHICISTS

Philosophers, particularly moral philosophers, are increasingly being involved in public decision-making in areas which are seen to raise ethical issues. For example, Dame Mary Warnock chaired the ‘Committee of Inquiry into Human Fertilization and Embryology’ in the UK in 1982–4; the Philosophy Department at Auckland was commissioned by the Auckland Regional Authority to report on the ethical aspects of fluoridating the public water supply in 1990; and many of us are serving on ethics committees of various sorts. Not only are philosophers actually being called on or consulted, but many of us would argue that a philosophical contribution in such areas is essential. The involvement of moral philosophers in public policy decisions raises a question of professional ethics, viz, what role should a philosopher's own moral perspective or judgements play in the advice s/he gives, or contribution s/he makes, to public decision-making on ethical issues. Like most problems in professional ethics, this prompts reflection on the nature of the profession, and in particular on the expertise we take moral philosophy to offer. It also prompts reflection on how processes of public decision making in ethically problematic areas should be understood. I explore these issues in this paper.     

Spécificité des dilemmes éthiques résultant des travaux développés en neurosciences: émergence d’une neuroéthique

As neurosciences improve our knowledge about the brain for defining behaviour, medical ethics and social policy, what are the implications of new possibilities of technical intervention on our brain? Neuroethics defines a new field of ethics where scientists and ethicists, and also journalists and politicians, are beginning to reflect on social issues resulting from applications of the work of neuroscience in areas such as moral vision, decision-making, conduct and policies. It is likely that the potential application of new knowledge to human behaviour will generate a great deal of ethical and public policy concern in many aspects of everyday life, from child care and school programs to improvements or maintenance of adult capabilities. Neuroscience will also challenge social fields as diverse as forensic psychiatry, sports, corporate hiring and the judiciary. As neurosciences advance, it is important to have a framework that might help to guide the utilization of the new knowledge.     

EMPIRICAL ETHICS AS DIALOGICAL PRACTICE

In this article, we present a dialogical approach to empirical ethics, based upon hermeneutic ethics and responsive evaluation. Hermeneutic ethics regards experience as the concrete source of moral wisdom. In order to gain a good understanding of moral issues, concrete detailed experiences and perspectives need to be exchanged. Within hermeneutic ethics dialogue is seen as a vehicle for moral learning and developing normative conclusions. Dialogue stands for a specific view on moral epistemology and methodological criteria for moral inquiry. Responsive evaluation involves a structured way of setting up dialogical learning processes, by eliciting stories of participants, exchanging experiences in (homogeneous and heterogeneous) groups and drawing normative conclusions for practice. By combining these traditions we develop both a theoretical and a practical approach to empirical ethics, in which ethical issues are addressed and shaped together with stakeholders in practice. Stakeholders' experiences are not only used as a source for reflection by the ethicist; stakeholders are involved in the process of reflection and analysis, which takes place in a dialogue between participants in practice, facilitated by the ethicist. This dialogical approach to empirical ethics may give rise to questions such as: What contribution does the ethicist make? What role does ethical theory play? What is the relationship between empirical research and ethical theory in the dialogical process? In this article, these questions will be addressed by reflecting upon a project in empirical ethics that was set up in a dialogical way. The aim of this project was to develop and implement normative guidelines with and within practice, in order to improve the practice concerning coercion and compulsion in psychiatry.     

Great Expectations: Teaching Ethics to Medical Students in South Africa

Many academic philosophers and ethicists are appointed to teach ethics to medical students. We explore exactly what this task entails. In South Africa the Health Professions Council's curriculum for training medical practitioners requires not only that students be taught to apply ethical theory to issues and be made aware of the legal and regulatory requirements of their profession, it also expects moral formation and the inculcation of professional virtue in students. We explore whether such expectations are reasonable. We defend the claim that physicians ought to be persons of virtuous character, on the grounds of the social contract between society and the profession. We further argue that since the expectations of virtue of health care professionals are reasonable, it is also sound reasoning to expect ethics teachers to try to inculcate such virtues in their students, so far as this is possible. Furthermore, this requires of such teachers that they be suitable role models of ethical practice and virtue, themselves. We claim that this applies to ethics teachers who are themselves not members of the medical profession, too, even though they are not bound by the same social contract as doctors. We conclude that those who accept employment as teachers of ethics to medical students, where as part of their contractual obligation they are expected to inculcate moral values in their students, ought to be prepared to accept their responsibility to be professionally ethical, themselves.     

Animal psychology and ethology in Britain and the emergence of professional concern for the concept of ethical cost

It has been argued that if an animal is psychologically like us, there may be more scientific reason to experiment upon it, but less moral justification to do so. Some scientists deny the existence of this dilemma, claiming that although there are scientifically valuable similarities between humans and animals that make experimentation worthwhile, humans are at the same time unique and fundamentally different. This latter response is, ironically, typical of pre-Darwinian beliefs in the relationship between human and non-human animals. Another irony is that debate about such issues has facilitated the participation once more of philosophers in questions concerning experimental psychology: ironic because laboratory-oriented psychologists, especially since the turn of the last century, had been eager to establish the independence of their subject from any influence of philosophy and its investigative methods, as well as from any kind of anthropomorphism.In Britain, certainly more so than in the United States, ethical constraints have prevented the development of psychological research with animals along certain routes. By the 1980s British professional and academic societies had published codes of conduct and guidelines for their members, in part responding to public concern about the welfare of animals in the psychological laboratory. What led to the establishment of these codes and guidelines? This paper analyses the historical background against which professional concern for ethical cost in experimental animal psychology began to take shape, leading to the societies’ open pronouncements of the 1980s.     

Public consultation in ethics an experiment in representative ethics

Genome Canada has funded a research project to evaluate the usefulness of different forms of ethical analysis for assessing the moral weight of public opinion in the governance of genomics. This paper will describe a role of public consultation for ethical analysis and a contribution of ethical analysis to public consultation and the governance of genomics/biotechnology. Public consultation increases the robustness of ethical analysis with a more diverse set of moral experiences. Consultation must be carefully and respectfully designed to generate sufficiently diverse and rich accounts of moral experiences. Since dominant groups tend to define ethical or policy issues in a manner that excludes some interests or perspectives, it is important to identify the range of interests that diverse publics hold before defining the issue and scope of the discussion and the premature foreclosure of ethical dialogue. Consequently, a significant contribution of ethical dialogue strengthened by social analysis is to consider the context and non-policy use of power to govern genomics and to sustain social debate on enduring ethical issues.     

Responsibility in the life sciences: assessing the role of professional codes

In response to threats from bioweapons, questions are being asked today in some countries about the implications and appropriateness of biological research. Many organizations and governments have suggested that bioscientists adopt what is generally referred to as a "code of conduct" to reduce the security concerns associated with their work. This article examines the potential contribution of such codes. By drawing on past lessons in other areas of professional life, it suggests some key questions, issues, and dilemmas for future consideration. As argued, attempts to establish codes must address demanding questions about their aims and audience--questions whose answers depend on potentially contentious issues regarding arms control, science, ethics, and politics.     

Moral philosophy and public policy: the case of NRTs

In this paper, I will express some reservations about the usefulness of moral philosophy for the analysis of public policy issues.... My question is whether taking morality seriously requires taking moral philosophy seriously. This paper focuses on one particular public policy context -- namely, government commissions into new reproductive technologies, such as Britain's Warnock Committee, Australia's Waller and Michael Committees, Canada's Baird Commission, and many others.... Moral philosophers are sometimes asked to participate in these commissions, either as Commissioners, staff, or expert advisers. How can moral philosophers contribute to the analysis of public policy recommendations on NRTs? A survey of the literature suggests that there are two main views on this question, one of which is ambitious, the other more modest. The ambitious view says that moral philosophers should attempt to persuade Commissioners to adopt the right comprehensive moral theory (e.g. adopt a deontological theory, rather than utilitarianism or contractarianism), and then apply this theory to particular policy questions. The more modest view shies away from promoting a particular moral theory, given that the relative merits of different moral theories are a subject of dispute even amongst moral philosophers. Instead, it says that moral philosophers should attempt to ensure that the Commission's arguments are clear and consistent. On this view, philosophers should focus on identifying conceptual confusions or logical inconsistencies within the Commission's arguments without seeking to influence its choice of the underlying theory.     

Psychiatric ethics

Psychiatric ethics spans several overlapping domains, including the guidelines for ethical research in psychiatry, the professional ethics required in the practice of psychiatry, and a broader set of moral and ethical problems and dilemmas distinctive to, or at least magnified by, the mental health care setting. Reviewed here are selected issues arising in the last two domains, some seemingly inevitable components of mental disorder and its cultural history and others resultant from recent changes and discoveries. Even as science explains and demystifies mental disorder, it is concluded, new ethical problems will continue to arise in psychiatry and certain recalcitrant problems will likely persist.     

Public Health Ethics and a Status for Pets as Person-Things

Within the field of medical ethics, discussions related to public health have mainly concentrated on issues that are closely tied to research and practice involving technologies and professional services, including vaccination, screening, and insurance coverage. Broader determinants of population health have received less attention, although this situation is rapidly changing. Against this backdrop, our specific contribution to the literature on ethics and law vis-à-vis promoting population health is to open up the ubiquitous presence of pets within cities and towns for further discussion. An expanding body of research suggests that pet animals are deeply relevant to people’s health (negatively and positively). Pet bylaws adopted by town and city councils have largely escaped notice, yet they are meaningful to consider in relation to everyday practices, social norms, and cultural values, and thus in relation to population health. Nevertheless, not least because they pivot on defining pets as private property belonging to individual people, pet bylaws raise emotionally charged ethical issues that have yet to be tackled in any of the health research on pet ownership. The literature in moral philosophy on animals is vast, and we do not claim to advance this field here. Rather, we pragmatically seek to reconcile philosophical objections to pet ownership with both animal welfare and public health. In doing so, we foreground theorizations of personhood and property from sociocultural anthropology.     

Moral Philosophy,Moral Expertise,and the Argument from Disagreement

Several recent articles have weighed in on the question of whether moral philosophers can be counted as moral experts. One argument denying this has been rejected by both sides of the debate. According to this argument, the extent of disagreement in modern moral philosophy prevents moral philosophers from being classified as moral experts. Call this the Argument From Disagreement (AD). In this article, I defend a version of AD. Insofar as practical issues in moral philosophy are characterized by disagreement between moral philosophers who are more or less equally well credentialed on the issue, non‐philosophers have no good reasons to defer to their views.     

Are there Characteristics of Infectious Diseases that Raise Special Ethical Issues?1

This paper examines the characteristics of infectious diseases that raise special medical and social ethical issues, and explores ways of integrating both current bioethical and classical public health ethics concerns. Many of the ethical issues raised by infectious diseases are related to these diseases' powerful ability to engender fear in individuals and panic in populations. We address the association of some infectious diseases with high morbidity and mortality rates, the sense that infectious diseases are caused by invasion or attack on humans by foreign micro-organisms, the acute onset and rapid course of many infectious diseases, and, in particular, the communicability of infectious diseases. The individual fear and community panic associated with infectious diseases often leads to rapid, emotionally driven decision making about public health policies needed to protect the community that may be in conflict with current bioethical principles regarding the care of individual patients. The discussion includes recent examples where dialogue between public health practitioners and medical-ethicists has helped resolve ethical issues that require us to consider the infected patient as both a victim with individual needs and rights and as a potential vector of disease that is of concern to the community.     

<Emphasis Type="BoldItalic">The President’s Physician: An African Play</Emphasis>

This review examines issues relating to biomedical ethics and literature in the African drama The President’s Physician by Emmanuel Babatunde Omobowale. The play investigates the psychological dilemma of Doctor Bituki Warunga, a personal physician to General Kalunga Ntibantunganyah who brutally and inhumanely rules Wavaria, a fictional African country. The doctor is faced with deciding to uphold the ethics of his profession versus terminating the tyrant’s life to set the nation free. The play aims to help budding medical doctors rightly inculcate the principles of medical ethics—autonomy, beneficence, competence, and power—by providing a fictional platform to investigate difficult issues that can arise in clinical practice. The play highlights Warunga’s complex dilemma as he struggles to uphold the Hippocratic Oath and at the same time satisfy his conscience towards his contribution to his country’s freedom. This review explores the difficulties in decision-making when professional duties not only clash with personal preferences but also with the well-being of an entire nation. This discussion is done alongside the ethical concept of utilitarianism and also highlights significant literary concepts such as satire, symbolism, intertextuality, utopian aesthetics, and authorial vision as conveyed in the text.     

Anorexia Nervosa: The Diagnosis

This paper argues that there is a relationship between understandings of anorexia nervosa (AN) and how the ethical issues associated with involuntary treatment for AN are identified, framed, and addressed. By positioning AN as a construct/discourse (hereinafter “AN: the diagnosis”) several ethical issues are revealed. Firstly, “AN: the diagnosis” influences how the autonomy and competence of persons diagnosed with AN are understood by decision-makers in the treatment environment. Secondly, “AN: the diagnosis” impacts on how treatment and treatment efficacy are defined and the ethical justifiability of paternalism. Thirdly, “AN: the diagnosis” can limit the opportunity for persons with AN to construct an identity that casts them as a competent person. “AN: the diagnosis” can thus inherently affirm professional knowledge and values. Postmodern professional ethics can support professionals in managing these issues by highlighting the importance of taking responsibility for professional knowledge, values, and power and embracing moral uncertainty.     

After Dolly--ethical limits to the use of biotechnology on farm animals

The cloning of Dolly the sheep gave rise to a widespread call for limits on interference with life. Until recently, the main limits were technical: what it is possible to do. Now scientists are faced with ethical limits as well: what it is acceptable to do. In this context, we take ethics to involve systematic and rational reflection on moral issues raised in the public sphere. The concerns of the general public are not necessarily valid, but they are the best point of departure if the discussion is to lead to a socially robust framework for setting limits to the use of animal biotechnology. To assess public understanding, we examine two sources of data: Eurobarometer surveys from 1991 to 2002 and a qualitative interview study carried out in Denmark in 2000. Based on these sources, we formulate, and then discuss closely, the following concerns: dangers to human health and the environment, animal welfare, animal integrity, and usefulness. In the final part of the article, it is proposed that a principle of proportionality should be the foundation for socially robust applications of animal biotechnology. Only in cases where the usefulness of the technology can be said to outweigh countervailing moral concerns, as in biomedical research, will applications of animal biotechnology stand up to scrutiny in the public sphere.     

Current trends in teaching ethics of healthcare practices

The unprecedented progress in bio-medical sciences and technology during the last few decades has resulted in great transformations in the concepts of health and disease, health systems and healthcare organisation and practices. Those changes have been accompanied by the emergence of a broad range of ethical dilemmas that confront health professionals more frequently. The classical Hippocratic ethical principles, though still retaining their relevance and validity, have become insufficiently adequate in an increasing range of problems and situations. Healthcare that has been practised for centuries on the basis of a direct doctor-patient relationship has been increasingly transformed into a more complex process integrating the health-team, the patient (healthcare seeker) and the community. Systematic review of the specialised literatures revealed that Healthcare Ethics education has become a basic requirement for any training programme for health professionals, and should cover the different stages of undergraduate, postgraduate and continuing education. Both theoretical foundations and practical skills are required for the appropriate ethical reasoning, ethical attitude and decision-making abilities. There is growing evidence that physicians' professional and moral development is not only determined by the formal curriculum of ethics; rather more, it is determined by the moral environment of the professional practice, the 'hidden curriculum' which deserves serious consideration by medical education.     

Bioethics andCara Sui

Cara sui (care of the self) is a guiding thread in Foucault's later writings on ethics. Following Foucault in that inquiry, we are urged beyond our fairly superficial conceptions of consequences, harms, benefits, and the rights of persons, and led to examine ourselves and try to articulate the sense of life that animates ethical reasoning. The result is a nuanced understanding with links to virtue ethics and post-modern approaches to ethics and subjectivity. The approach I have articulated draws on the phenomenology of Levinas and Heidegger, the Virtue ethics of Baier, and the post-structuralist writing of Michel Foucault. The subject is seen as negotiable, embodied, provisional and able to be transformed in a way that denies essentialism about human beings, their moral status, and the idea of the good. The human being emerges as responsible because, properly, responsive to the context of discourse in which morality becomes articulated. When we import this style of thinking into bioethics we find that it reaches beyond issues of policy or right conduct and allows us to use the biomedical sciences and the clinical world to revise and interrogate our understanding of ourselves and the theoretical foundations of health care ethics.     

On Cloning: Advocating History of Biology in the Public Interest

Cloning – the process of creating a cell, tissue line or even a complete organism from a single cell – or the strands that led to the cloning of a mammal, Dolly, are not new. Yet the media coverage of Dolly's inception raised a range of reactions from fear or moral repulsion, to cautious optimism. The implications for controlling human reproduction were clearly in the forefront, though many issues about animals emerged as well. On topics of public interest such as cloning, historians of biology have the opportunity to make a unique contribution. Such debates are often aired as if they have no precedents, either in biology or in the ethical, moral, and social concerns arising in the public arena. The technology leading to Dolly draws on strands of research going back to the 1890s, and the cycle of public response has been repeated often in the past century. What can we learn from examining these events historically, and how can we – or should we even try – to inform public opinion? I think we should try and will outline briefly some of the ways that can work.     

Module one: introduction to research ethics

This module will introduce you to the ethical concepts underlying applied ethical decision-making in the area of research involving human participants. We will also learn what the issues are that people involved in research on research ethics are concerned with. Ethics without an understanding of historical and legal context makes arguably little sense. It is for this reason that this module will begin with a brief history of research ethics and ends with a brief overview of the relevant national and international guidelines pertaining to ethical issues in research involving human participants.     

Public health ethics: asylum seekers and the case for political action

This paper is a case study in public health ethics. It considers whether there is a basis in ethics for political action by health professionals and their associations in response to inhumane treatment. The issue arises from Australia's treatment of asylum seekers and the charge that this treatment has been both immoral and inhumane. This judgement raises several questions of broader significance in bioethics and of significance to the emerging field of public health ethics. These questions relate to the role of health professionals in response to inhumane treatment of people in their charge; to the discipline of public health in light of a growing recognition of its ethical basis; and the role of public health and bioethical associations in response to ethical issues arising in a political context. It is argued that, in serious cases of humanitarian and human rights abuses affecting health and well-being, there is a case for political action by health professionals, academic and professional institutions, and associations of public health and ethics.