Microethics in action

The future development of bioethics has been discussed in a number of articles in recent years, principally with regard to the trend towards empirical studies. However, what is meant by empirical studies in this context and how it is to be used concretely have been subject to varying interpretations. The purpose of this article is to develop what we term the microethical approach as a concrete method for an empirically driven bioethics. By adopting a microethical perspective, we will illustrate an analytical concept for describing and demonstrating how, as a result of contextual circumstances and forms of understanding, different individuals in their everyday life adopt different coping strategies and behavior patterns in relation to ethical values. From a deepened perspective, the complexity of human behavior becomes apparent, and knowledge is gained about how moral problems are perceived and construed by those whom they in fact affect. We intend first and foremost to develop the microethical methodology by elucidating the methods and approaches that can help in clarifying moral dilemmas on a microethical level, and how the relationship between the empirical material and the ethical analysis evolves over the course of the analysis. This is exemplified by a study of caregivers' entrance into patients' private lives through the provision of care and assistance in the home.     

Learning to navigate the ethics of boundaries: schools,youth, and inter-religious relationships in Manado,Indonesia

Contributing to recent debates on ethical self-making, this article considers how Christian and Muslim youth in Manado, Indonesia, draw on various moral frameworks, and consequentially on both individual and community-oriented modes of subjectivity in navigating inter-religious encounters. The discussion foregrounds attitudes towards and normative expectations regarding inter-religious marriage as an important lens through which the shifting salience of inter-religious boundaries becomes apparent. Public discourses emphasize two contradictory frameworks for coexistence, projecting inter-religious marriage alternatively as the foundation for coexistence and as a major social threat. A focus on high schools demonstrates how public ethical debates are channelled through institutions and relate to the ways that youth grapple with coexisting ethical frameworks in a religiously plural society. In addition, the article makes a case for investigating the role of institutions in moral learning, taking into account the normative work accomplished in schools as teachers and students deliberate about and circulate ethical frameworks.     

The ethics and obligations of long-term ethnographic relationships: revelatory moments and the concept of solidarity

This article reflects on an ethical and revelatory moment in the development of my long-term fieldwork relationships with people of the Lihir Islands in Papua New Guinea. Ethnographic research globally is now shaped through formal processes of ethical review, with the requirements for informed consent, privacy, and consideration of harm and beneficence. Researchers then have to put these procedures into practice, often encountering the need to weigh competing ethical principles, particularly when unforeseen events occur. Reflexivity has been argued to be crucial on these occasions. Yet both ethical codes and reflexivity fall short of managing ethical and relational implications of long-term field relationships. This article suggests that the concept of solidarity as theorized recently in bioethics may be helpful, particularly the discernment of three layers of relationship. What responsibilities might we as anthropologists have to the people we work with that go beyond procedural ethics? And how do moments such as the one described in this article shape ongoing field research?     

From applied ethics to empirical ethics to contextual ethics

Bioethics became applied ethics when it was assimilated to moral philosophy. Because deduction is the rationality of moral philosophy, subsuming facts under moral principles to deduce conclusions about what ought to be done became the prescribed reasoning of bioethics, and bioethics became a theory comprised of moral principles. Bioethicists now realize that applied ethics is too abstract and spare to apprehend the specificity, particularity, complexity and contingency of real moral issues. Empirical ethics and contextual ethics are needed to incorporate these features into morality, not just bioethics. The relevant facts and features of problems have to be identified, investigated and framed coherently, and potential resolutions have to be constructed and assessed. Moreover, these tasks are pursued and melded within manifold contexts, for example, families, work and health care systems, as well as societal, economic, legal and political backgrounds and encompassing worldviews. This naturalist orientation and both empirical ethics and contextual ethics require judgment, but how can judgment be rational? Rationality, fortunately, is more expansive than deductive reasoning. Judgment is rational when it emanates from a rational process of deliberation, and a process of deliberation is rational when it uses the resources of non‐formal reason: observation, creative construction, formal and informal reasoning methods and systematic critical assessment. Empirical ethics and contextual ethics recognize that finite, fallible human beings live in complex, dynamic, contingent worlds, and they foster creative, critical deliberation and employ non‐formal reason to make rational moral judgments.     

Moving beyond bioethics: history and the search for medical humanism

From both within and without bioethics, growing criticism of the predominant methods and practices of the field can be heard. These critiques tend to lament an emphasis on logically derived rules and philosophical theories that inadequately capture how and why people have the moral attitudes they do, and they urge the use of more empirically grounded social sciences--history, sociology, and anthropology--to draw attention to the complex factors behind such attitudes. However, these critiques do not go far enough, as they do not question why debate over ethical categories should have such a central role in voicing concerns about medicine. The importance of using other forms of inquiry, especially that of history, to examine aspects of medical practice and the emergence of bioethics itself is not simply to refine bioethical moral analysis. Instead, history can be employed to counter the preoccupation with translating concerns about medicine into moral terms and to move towards what is more sorely needed: a true medical humanism.     

On fun and freedom: young women's moral learning in Indonesian Islamic boarding schools

This article analyses the role of fun and freedom in the moral learning of young women students in two Indonesian Islamic boarding schools. Recent debates about Islam and ethical subject formation have centred on the assumed tension between Islam and freedom. I examine decisions about television viewing and dress to illustrate both the flexibility and fixity of moral values and evaluation in girls’ lives. I argue that anthropologists of morality and Islam should take seriously moments of fun as important instances for ‘moral ludus’ or ‘moral play’ – the testing, shifting, and reshaping of the boundaries of moral behaviours that involve balancing the demands of various social fields and the larger ethical community in which a person is embedded. I suggest that these moments be viewed not as ruptures or instances of hypocrisy but as everyday occurrences of embedded agency in the lives of piety-minded individuals.     

A scientist's view of the ethics of human embryonic stem cell research

Scientists are rarely immoral and seldom even amoral. The ethical principles that underlie much of their own work are shared with scientists in other countries to a much greater degree than the cultural and religious differences among those countries would lead one to expect. Like me, few will have had any formal training in bioethics; so how might life scientists approach the varied ethical issues that arise in human embryo and stem cell research?     

An undignified bioethics: there is no method in this madness

In a recent article, Alasdair Cochrane argues for the need to have an undignified bioethics. His is not, of course, a call to transform bioethics into an inelegant, pathetic discipline, or one failing to meet appropriate disciplinary standards. His is a call to simply eliminate the concept of human dignity from bioethical discourse. Here I argue that he fails to make his case. I first show that several of the flaws that Cochrane identifies are not flaws of the conceptions of dignity he discusses but rather flaws of his, often problematic, understanding of such conceptions. Second, I argue that Cochrane's case against the concept of human dignity goes too far. I thus show that were one to agree that these are indeed flaws that require that we discard our ethical concepts, then following Cochrane's recommendations would commit us not only to an undignified bioethics, i.e. a bioethics without dignity, but to a bioethics without much ethics at all.     

The ethics of marriage in American evangelicalism

The idea that marriage should be treated as a site of pious ethical work is widespread in conservative Christian discourse. This article considers how and why conservative American evangelicals have come to regard the everyday routines of heterosexual marriage as potential forms of religious labour that can cultivate robust Christian subjectivities along with successful conjugal relationships. It argues that the notion of pious marital work was strongly shaped by the secular culture of therapeutic counselling and self-help that developed during the twentieth century. While pious ethics and secular, everyday ethics are often seen as distinct, this historical perspective illuminates the modern coevolution of secular and conservative religious conceptions of marriage, revealing how each has linked marital work to personal as well as societal redemption.     

‘Don't be so serious’: ethical play,Islam, and the transcendent

Modes of play and playfulness are central to ethics, yet have not been as rigorously considered by anthropologists as have more earnest forms of ethical life. In this article, I argue that attention to play reframes recent anthropological debates about ethical transcendence and immanence. I do so through a consideration of the Islamic discourse of ‘calculation’ (ḥisāb), an idiom by which Muslims articulate their hoped-for state in the hereafter through the imagery of a divine accounting of good and bad deeds. Drawing on ethnography from the Indonesian province of Aceh, I show how ḥisāb cultivates forms of epistemological play through which Muslims explore the inscrutability of transcendence. Such play reveals the socially and theologically emergent qualities of transcendent truths and values, suggesting hidden affinities between transcendent stances and more immanent forms of ethical life.     

Broken Brains and Broken Homes: The Meaning of Special Education in an Appalachian Community

In this article, I explore the meaning of disability within the everyday lives of Clear River third-grade students. The concept of a disability narrative is developed to explain how expert disability labels shape the experience of academic performance and failure. Previous studies of disability labeling have neglected the life of the label after it has become entextualized. I focus on how the layperson translates the technical language of experts into the moral language of everyday life.  [labeling, special education, narrative, discourse, cultural circulation]     

Medicare prospective payment--the ethical implications of converging clinical and financial decisions in long-term care

The principles of bioethics indicate that Prospective Payment has a moral dimension. Because Prospective Payment unifies clinical and financial decisions, it poses problems for long-term care facilities, especially those motivated by a humanitarian mission rather than financial considerations. This article outlines how Prospective Payment conflicts with the ethical principles of respect for persons, autonomy, justice, promise keeping, and fidelity.     

Heterogeneous assemblages of bioethics and science: the “pre-embryo” debate in America

This paper explores the “pre-embryo” debate in America to analyze the relationship between scientific uncertainty and moral decision-making. This paper explores how an ethical debate among bioethicists around the term “pre-embryo” has been transformed into a scientific “fact” debate between developmental biology and embryology. This transformation is driven by the scientism of ethical reasoning that stresses scientific claims to increase the credibility of ethical claims. This paper concludes that the “pre-embryo” debate is not an ethical controversy over a unified science but rather credibility struggles between two heterogeneous assemblages of science and bioethics.     

Social Responsibility and the State's Duty to provide Healthcare: An Islamic Ethico‐Legal Perspective

The United Nations Educational, Scientific and Cultural Organization's (UNESCO) Declaration on Bioethics and Human Rights asserts that governments are morally obliged to promote health and to provide access to quality healthcare, essential medicines and adequate nutrition and water to all members of society. According to UNESCO, this obligation is grounded in a moral commitment to promoting fundamental human rights and emerges from the principle of social responsibility. Yet in an era of ethical pluralism and contentions over the universality of human rights conventions, the extent to which the UNESCO Declaration can motivate behaviors and policies rests, at least in part, upon accepting the moral arguments it makes. In this essay I reflect on a state's moral obligation to provide healthcare from the perspective of Islamic moral theology and law. I examine how Islamic ethico‐legal conceptual analogues for human rights and communal responsibility, ?uqūq al‐’ibād and far? al‐kifāyah and other related constructs might be used to advance a moral argument for healthcare provision by the state. Moving from theory to application, I next illustrate how notions of human rights and social responsibility were used by Muslim stakeholders to buttress moral arguments to support American healthcare reform. In this way, the paper advance discourses on a universal bioethics and common morality by bringing into view the concordances and discordances between Islamic ethico‐legal constructs and moral arguments advanced by transnational health policy advocates. It also provides insight into applied Islamic bioethics by demonstrating how Islamic ethico‐legal values might inform the discursive outputs of Muslim organizations.     

WHAT CAN HISTORY DO FOR BIOETHICS?

This article details the relationship between history and bioethics. I argue that historians' reluctance to engage with bioethics rests on a misreading of the field as solely reducible to applied ethics, and overlooks previous enthusiasm for historical perspectives. I claim that seeing bioethics as its practitioners see it – as an interdisciplinary meeting ground – should encourage historians to collaborate in greater numbers. I conclude by outlining how bioethics might benefit from new histories of the field, and how historians can lend a fresh perspective to bioethical debates.     

The Nature and Value of Bioethics Expertise

In this article, I address the extent to which experts in bioethics can contribute to healthcare delivery by way of aid in clinical decision‐making and policy‐formation. I argue that experts in bioethics are moral experts, in that their substantive moral views are more likely to be correct than those of non‐bioethicists, all else being equal, but that such expertise is of use in a relatively limited class of cases. In so doing, I respond to two recent arguments against the view that bioethicists are moral experts, one by Christopher Cowley and another by David Archard. I further argue that bioethics experts have significant additional contributions to make to healthcare delivery, and highlight a hitherto neglected aspect of that contribution: amelioration of moral misconception among clinicians. I describe in detail several aspects of moral misconception, and show how the bioethicist is in a prime position to resolve that sort of error.     

FROM INTEGRATIVE BIOETHICS TO PSEUDOSCIENCE

Integrative bioethics is a brand of bioethics conceived and propagated by a group of Croatian philosophers and other scholars. This article discusses and shows that the approach encounters several serious difficulties. In criticizing certain standard views on bioethics and in presenting their own, the advocates of integrative bioethics fall into various conceptual confusions and inconsistencies. Although presented as a project that promises to deal with moral dilemmas created by modern science and technology, integrative bioethics does not contain the slightest normativity or action‐guiding capacity. Portrayed as a scientific and interdisciplinary enterprise, integrative bioethics displays a large number of pseudoscientific features that throw into doubt its overall credibility.     

Spreading disease: a controversy concerning the metaphysics of disease.

This article concerns the metaphysics of disease. Is disease a fixed feature of the world or a social value or preference? I argue that disease is not a value-laden concept and thus debates concerning it differ fundamentally from debates concerning health, harm, or suffering where evaluative judgements are central. I show how the so-called social constructionist view of disease has been motivated both by ethical concerns with medical practices and general theoretical doubts about scientific naturalism. If I can show that ethical concerns about medical treatment can be answered without adopting social constructionism, that leaves only the broader theoretical question of naturalism. I cannot completely answer those theoretical doubts, but I show that the theoretical motivation is less convincing when it is separated from the moral challenge often accompanying it. I conclude that a convincing defense of the non-naturalistic conception of disease is rarely attempted and proves more difficult and counter-intuitive than its proponents assume.     

Alternative consent models for biobanks: the new Spanish law on biomedical research

This article provides an overview of recent contributions to the debate on the ethical use of previously collected biobank samples, as well as a country report about how this issue has been regulated in Spain by means of the new Biomedical Research Act, enacted in the summer of 2007. By contrasting the Spanish legal situation with the wider discourse of international bioethics, we identify and discuss a general trend moving from the traditional requirements of informed consent towards new models more favourable to research in a post-genomic context.