Bioethics critically reconsidered : having second thoughts

201 Pages·2012·1.977 MB·English

by  Engelhardt, Hugo Tristram

BIOETHICSCRITICALLYRECONSIDERED
Philosophy and Medicine
VOLUME 100
FoundingCo-Editor
StuartF.Spicker
SeniorEditor
H.TristramEngelhardt,Jr.,DepartmentofPhilosophy,RiceUniversity,
andBaylorCollegeofMedicine,Houston,Texas
AssociateEditor
LisaM.Rasmussen,DepartmentofPhilosophy,UniversityofNorthCarolina
atCharlotte,Charlotte,NorthCarolina
AssistantEditor
JeffreyP.Bishop,GnaegiCenterforHealthCareEthics,SaintLouisUniversity,
St.Louis,Missouri
EditorialBoard
GeorgeJ.Agich,DepartmentofPhilosophy,BowlingGreenStateUniversity,
BowlingGreen,Ohio
NicholasCapaldi,CollegeofBusinessAdministration,LoyolaUniversity,
NewOrleans,Louisiana
EdmundErde,UniversityofMedicineandDentistryofNewJersey,Stratford,
NewJersey
ChristopherTollefsen,DepartmentofPhilosophy,UniversityofSouthCarolina,
Columbia,SouthCarolina
KevinWm.Wildes,S.J.,PresidentLoyolaUniversity,NewOrleans,
Louisiana
Forfurthervolumes:
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BIOETHICS CRITICALLY
RECONSIDERED
Having Second Thoughts
Editedby
H.TRISTRAMENGELHARDT,JR.
RiceUniversity,Houston,TX,USA
123
Editor
H.TristramEngelhardt,Jr.Ph.D.
MainSt6100
77005-1827HOUSTONTexas
USA
[email protected]
ISSN0376-7418
ISBN978-94-007-2243-9 e-ISBN978-94-007-2244-6
DOI10.1007/978-94-007-2244-6
SpringerDordrechtHeidelbergLondonNewYork
LibraryofCongressControlNumber:2011938240
©SpringerScience+BusinessMediaB.V.2012
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Contents
1 ASkepticalReassessmentofBioethics . . . . . . . . . . . . . . . . 1
H.TristramEngelhardt,Jr.
PartI HistoryofBioethics:FourPerspectives
2 BeginningBioethics. . . . . . . . . . . . . . . . . . . . . . . . . . . 31
MichaelS.Yesley
3 GenesisofaTotalizingIdeology:Bioethics’InnerHippie . . . . . . 49
GriffinTrotter
4 Bioethics and Professional Medical Ethics: Mapping
andManaginganUneasyRelationship . . . . . . . . . . . . . . . . 71
LaurenceB.McCullough
5 Two Rival Understandings of Autonomy, Paternalism,
andBioethicalPrinciplism . . . . . . . . . . . . . . . . . . . . . . . 85
AaronE.Hinkley
PartII The Practice of Bioethics and Clinical Ethics
Consultation:ThreeViews
6 BioethicsasPoliticalIdeology . . . . . . . . . . . . . . . . . . . . . 99
MarkJ.Cherry
7 The“s”inBioethics:Past,PresentandFuture . . . . . . . . . . . . 123
AnaS.IltisandAdrienneCarpenter
8 WhyClinicalBioethicsSoRarelyGivesMorallyNormative
Guidance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
H.TristramEngelhardt,Jr.
v
vi Contents
PartIII TheIncredibleSearchforBioethicalProfessionalism:
SomeFinalCriticalReflectionsonCircularThinking
9 OntheSocialConstructionofHealthCareEthicsConsultation . . 177
JeffreyP.Bishop
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Contributors
JeffreyP.Bishop AlbertGnaegiCenterforHealthCareEthics,SaintLouis
University,SalusCenter,Room527,3545LafayetteAve,St.Louis,MO63104,
USA,[email protected]
AdrienneCarpenter AlbertGnaegiCenterforHealthCareEthics,SaintLouis
University,St.Louis,MO63104,USA,[email protected]
MarkJ.Cherry TheDr.PatriciaA.HayesProfessorinAppliedEthics,Professor
ofPhilosophy,DepartmentofPhilosophy,St.Edward’sUniversity,Austin,
TX78704,USA,[email protected]
H.TristramEngelhardt,Jr. DepartmentofPhilosophy,MS-14,RiceUniversity,
Houston,TX77005,USA,[email protected]
AaronE.Hinkley DepartmentofPhilosophy,MS-14,RiceUniversity,Houston,
TX77005,USA,[email protected]
AnaS.Iltis CenterforBioethics,HealthandSociety,WakeForestUniversity,
Winston-Salem,NC27109,USA,[email protected]
LaurenceB.McCullough DaltonTomlinChairinMedicalEthicsandHealth
Policy,BaylorCollegeofMedicine,CenterforMedicalEthicsandHealthPolicy,
Houston,TX77030-2411,USA,[email protected]
GriffinTrotter AlbertGnaegiCenterforHealthCareEthics,SalusCenter,Saint
LouisUniversity,St.Louis,MO63104,USA,[email protected]
MichaelS.Yesley IndependentConsultant,BainbridgeIsland,WA98110,USA,
[email protected]
vii
Notes on Contributors
JeffreyP.Bishop,M.D.,Ph.D.,isdirectoroftheAlbertGnaegiCenterforHealth
Care Ethics and Tenet Chair of Health Care Ethics at Saint Louis University,
St.Louis,Missouri.
Adrienne Carpenter, is professor at the Albert Gnaegi Center for Health Care
EthicsatSaintLouisUniversity,St.Louis,Missouri.
Mark J. Cherry, Ph.D., is the Dr. Patricia A. Hayes Professor in Applied Ethics,
DepartmentofPhilosophy,St.Edward’sUniversityAustin,Texas.
H.TristramEngelhardt,Jr.,Ph.D.,M.D.,isprofessor,departmentofphilosophy,
Rice University, and professor emeritus, departments of medicine and community
medicine,BaylorCollegeofMedicine,Houston,Texas.
AaronE.Hinkley,ABD,isadoctoralcandidateinthedepartmentofphilosophy,
RiceUniversity,Houston,TexasandanadjunctprofessorofphilosophyatHouston
BaptistUniversity.HeisalsotheseniormanagingeditorofTheJournalofMedicine
andPhilosophy.
Ana S. Iltis, Ph.D., is Director of the Center for Bioethics, Health and Society
andassociateprofessorofphilosophyatWakeForestUniversityinWinston-Salem,
NorthCarolina.
LaurenceB.McCullough,Ph.D.,istheassociatedirectorforEducationandinau-
guralholderoftheDaltonTomlinChairinMedicalEthicsandHealthPolicyinthe
CenterforMedicalEthicsandHealthPolicy,BaylorCollegeofMedicine,whereis
healsoprofessorofMedicineandMedicalEthics.
Griffin Trotter, M.D., Ph.D., is professor at the Center for Health Care Ethics
at Saint Louis University, St. Louis, Missouri. He also has an appointment in the
DepartmentofSurgery,EmergencyMedicalDivisioninSchoolofMedicineatSaint
LouisUniversity.
MichaelS.Yesley,J.D.,isanattorneyandwritesaboutbioethics,particularlyissues
ingeneticsandresearchwithhumansubjects.HerecentlyretiredfromLosAlamos
NationalLaboratory(LANL).
ix
Chapter 1
A Skeptical Reassessment of Bioethics
H.TristramEngelhardt,Jr.
1.1 WhatIsBioethics,AfterAll:ClaimsforMoralExpertise
intheFaceofIntractableMoralPluralism
What is bioethics? Who is a bioethicist? Who is a health care ethics consultant or
clinicalethicsconsultant?Therearenostraightforwardanswerstosuchquestions.
Indeed, the attempt to answer such questions usually engenders controversies.
Bioethicsisapuzzle.Bioethicsisitselfacontroversy,atheaterofdispute.Across
the world, there are persons who call themselves bioethicists. But there is no
agreement as to what ends they are doing what they do, as to what they should
be doing, or even as to what they are doing. In hospitals across the world, there
are persons who are paid as clinical ethics consultants (aka health care ethics
consultants) and who are often held to be engaged in helping resolve normative
questionsabouthealthcaredecisions.Butthereisnoagreementastowhatnorms
they should engage. This is because there is real dispute about the content and
character of both morality and bioethics. As a result, there is a puzzle as to how
properlytocharacterizethenatureofthenormativequestionsposedtobioethicists,
aswellastheanswersbioethicistsgive.Bioethicistsareasked,forexample,about
when a particular medical intervention is inappropriate (or futile), about who
should make life-or-death decisions, and concerning what information should be
provided in order for a patient adequately to consent to treatment. The question is
what kinds of norms and which ethics should frame such questions. In answering
such questions, what norms and which norms should guide the answers? Are the
normsatstakethoseestablishedatlaw?Istheethicsaboutwhichhealthcareethics
consultants (HCEC) give advice simply an account of relevant law and public
policy, as well as of how law and public policy is customarily applied? Or are
the norms moral norms? If so, norms of which morality? These puzzles about the
natureofbioethicsjustifysecondthoughtsabouttheentireendeavorofbioethics.
B
H.T.Engelhardt,Jr.( )
DepartmentofPhilosophy,MS-14,RiceUniversity,Houston,TX77005,USA
e-mail:[email protected]
H.T.Engelhardt,Jr.(ed.),BioethicsCriticallyReconsidered, 1
PhilosophyandMedicine100,DOI10.1007/978-94-007-2244-6_1,
(cid:2)C SpringerScience+BusinessMediaB.V.2012