Applying Nonideal Theory To Bioethics

This book offers new essays exploring concepts and applications of nonideal theory in bioethics. Nonideal theory refers to an analytic approach to moral and political philosophy (especially in relation to justice), according to which we should not assume that there will be perfect compliance with principles, that there will be favorable circumstances for just institutions and right action, or that reasoners are capable of being impartial. Nonideal theory takes the world as it actually is, in all of its imperfections. Bioethicists have called for greater attention to how nonideal theory can serve as a guide in the messy realities they face daily. Although many bioethicists implicitly assume nonideal theory in their work, there is the need for more explicit engagement with this theoretical outlook. A nonideal approach to bioethics would start by examining the sociopolitical realities of healthcare and the embeddedness of moral actors in those realities. How are bioethicists to navigate systemic injustices when completing research, giving guidance for patient care, and contributing to medical and public health policies? When there are no good options and when moral agents are enmeshed in their sociopolitical viewpoints, how should moral theorizing proceed? What do bioethical issues and principles look like from the perspective of historically marginalized persons? These are just a few of the questions that motivate nonideal theory within bioethics. This book begins in Part I with an overview of the foundational tenets of nonideal theory, what nonideal theory can offer bioethics, and why it may be preferable to ideal theory in addressing moral dilemmas in the clinic and beyond. In Part II, authors discuss applications of nonideal theory in many areas of bioethics, including reflections on environmental harms, racism and minority health, healthcare injustices during incarceration and detention, and other vulnerabilities experienced by patients from clinical and public health perspectives. The chapters within each section demonstrate the breadth in scope that nonideal theory encompasses, bringing together diverse theorists and approaches into one collection.

This book provides an overview and critical discussion of the main philosophical methods that have dominated the field of bioethics since its origins in the late 1960s and early 1970s. The first three chapters outline some influential theories that are important to understanding the methodological approaches that follow. Chapter 1 offers a survey of the theory of principlism as expounded by Tom Beauchamp and James Childress, Chapter 2 examines Bernard Gert's defense of common morality, and Chapter 3 discusses the so-called "new casuistry." The next three chapters trace a historical dialectic. Chapter 4 explores the shift that has increasingly occurred in bioethics away from the pursuit of objectivity or truth and towards narrative ethics, while Chapter 5 uncovers the "classical" roots of American pragmatism and explains their on-going relevance for contemporary bioethics. This paves the way for Chapter 6's examination of "freestanding" pragmatists such as Susan Wolf who, in contrast, see their approach as untethered to the classical canon of American pragmatism. With this background firmly established, the next two chapters handle some influential contemporary approaches. Chapter 7 considers the "internal morality" approach to medicine; chapter 8 discusses the method of reflective equilibrium. Chapter 9 summarizes and reflects on the results of the preceding eight chapters. Rather than staking out and defending a final position, the book aspires to uncover the advantages and disadvantages of the different methodological approaches. In the words of Kierkegaard, it aims to make life "harder" rather than "easier" for bioethics by uncovering some outstanding challenges.

Despite the massive scale of global inequalities, until recently few political philosophers or bioethicists addressed their ethical implications. Questions of justice were thought to be primarily internal to the nation state. Over the last decade or so, there has been an explosion of interest in the philosophical issues surrounding global justice. These issues are of direct relevance to bioethics. The links between poverty and health imply that we cannot separate questions of global health from questions about fair distribution of global resources and the institutions governing the world order. Similarly, as increasing numbers of medical trials are conducted in the developing world, researchers and their sponsors have to confront the special problems of doing research in an unjust world, with corresponding obligations to correct injustice and avoid exploitation. This book presents a collection of original essays by leading thinkers in political theory, philosophy, and bioethics. They address the key issues concerning global justice and bioethics from two perspectives. The first is ideal theory, which is concerned with the social institutions that would regulate a just world. What is the relationship between human rights and the provision of health care? How, if at all, should a global order distinguish between obligations to compatriots and others? The second perspective is from non-ideal theory, which governs how people should behave in the unjust world in which we actually find ourselves. What sort of medical care should actual researchers working in impoverished countries offer their subjects? What should NGOs do in the face of cultural practices with which they deem unethical? If coordinated international action will not happen, what ought individual states to do? These questions have more than theoretical interest; their answers are of direct practical import for policymakers, researchers, advocates, NGOs, scholars, and others. This book is the first collection to comprehensively address the intersection of global justice and bioethical dilemmas.

What is Bioethics? What are its goals and theoretical assumptions? Is it a unique discipline? Must medical ethics be grounded in clinical experience? How can ethical inquiry inform medicine's theory and practice? Must one have a definition of medicine before one can have a medical ethic? Does medicine have a unique or demarcating body of knowledge, methodology, or philosophy? These troubling questions are addressed by a distinguished roster of philosophers, theologians, lawyers, social scientists, physicians and scientists. The unifying theme of this text is a philosophical exploration of the history, nature, scope and foundations of bioethics. There is a critical evaluation of principled, communitarian, legal, narrative and feminist approaches. The book's interdisciplinary focus allows for a lively dialogue which includes papers and accompanying commentaries. Audience: Philosophers of science and medical ethicists, physicians, lawyers, policy makers.

How should we attempt to resolve concrete bioethical problems? How are we to understand the role of bioethics in the health care system, government, and academe? This collection of original essays raises these and other questions about the nature of bioethics as a discipline. The contributors to the volume discuss various approaches to bioethical thinking and the political and institutional contexts of bioethics, addressing underlying concerns about the purposes of its practice. Included are extended analyses of such important issues as the conduct of clinical trials, euthanasia, justice in health care, the care of children, cosmetic surgery, and reproductive technologies.

Bioethics today has become a subject of wide public concern. Almost every one of its tenets is being seriously questioned and likely to be reformulated. Moreover, the pressure on bioethics continues to mount as the number of moral conflicts that buffet our society increases. What, then, will bioethics look like a decade from now? In the variety of approaches that have been employed in the practice of bioethics, one has dominated in the United States in the last decade and a half. That approach is "principlism", the use of moral principles to address theoretical issues and to resolve conflicts at the bedside. Recently, however, bioethicists and others increasingly have realized the limitations of principlism and are calling for the development of alternative approaches such as phenomenology, hermeneutics, narrative ethics, casuistry, and virtue ethics. This book maps the debate over principlism and the future direction of U.S. bioethics. Part One consists of a sociological description of U.S. bioethics at the beginning of the 1990s, along with a defense of principlism by one of its major proponents. Part Two maps cross-cultural critiques of principlism, while Part Three covers five alternatives to it. Three essays in Part Four - by a bioethicist, a physician, and a theologian - reflect on the future of U.S. bioethics, principlism, and its alternatives. The Afterword emphasizes the place of religion and theological discourse in the alternative approaches and in the future of bioethics.

This book offers a systematic analysis of the moral principles that should apply to biomedicine. We understand "biomedical ethics" as one type of applied ethics. In our discussions of ethical theory per se, we offer anaylses of levels of moral deliberation and justification and of the ways two major approaches interpret principles, rules, and judgments. The systematic core of the book presents four fundamental moral principles--autonomy, beneficence, nonmaleficence, and justice.