What is "Bioethics"? pg.8

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1 The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report (Washington, D.C: U.S. Department of Health, Education, and Welfare, 1978) is the explicit (sometimes implicit) "ethical" basis for all of the following documents (a very small sample): United States Code of Federal Regulations: Protection of Human Subjects [OPRR] 45 CFR 46 (revised Jan. 12, 1981, Mar. 8, 1983; reprinted July 1989, revised 1991 - now in the Common Rule for all departments of the federal government which volunteer to comply), (Washington, D.C.: DHHS); The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, 10 individual Reports including Summing Up (Washington, D.C., U.S. Government Printing Office, 1983); National Institutes of Health: Report of the Human Fetal Transplant Research Panel (Washington, D.C.: NIH, December 1988); NIH Guide for Grants and Contracts (Washington, D.C.: NIH, 1990); Office for the Protection from Research Risks (OPRR), Protecting Human Research Subjects: Institutional Review Board Guidebook (Washington, D.C. NIH, 1993); National Institutes of Health: Report of the Human Embryo Research Panel (Washington, D.C.: NIH, Sept. 27, 1994); NIH Guidelines on the Inclusion of Women and Minorities as Subjects in Clinical Research, Federal Reg. 59 FR 14508 (Washington, D.C.: NIH, March 28, 1994); NIH Outreach Notebook On the Inclusion of Women and Minorities in Biomedical and Behavioral Research (Washington, D.C.: NIH, 1994); the CIOMS/WHO International Ethical Guidelines for Biomedical Research Involving Human Subjects (Geneva: CIOMS/WHO, 1993); the proposed legislation in the State of Maryland for the use of incompetent mentally ill patients in experimental research; the current NIH Human Pluripotent Stem Cell Research Guidelines, (2000). See also Jonsen, esp. Chapter 12. [Back]

2 Claims abound that such fields as "logic" or "meta-ethics" are inherently "neutral"; however further research demonstrates the fallacies in such claims. There are many different schools of "logic", each school using terms and definitions peculiar to very specific metaphysical and epistemological schools of philosophy (which determine the different terms and their definitions). That is, these different schools of "logic" drag with them very specific metaphysical and epistemological presuppositions. That is why the dozens of very different schools of "logic" come to different "logical" conclusions. See, e.g., the sections on "logic" in Paul Edwards (ed.), The Encyclopedia of Philosophy (New York: Macmillan Publishing Co., Inc. and The Free Press, 1967), Vols. 3/4 pp. 504-571; and Vols. 5/6 pp. 1-83. Thus there is no such thing as a "neutral logic". Similarly, if "meta-ethics" is defined as the "merely logical" analysis of ethical propositions, then by necessity "meta-ethics" too is not "neutral", but carries with it's use and the selection of its terms and analyses very specific metaphysical and epistemological presuppositions. See any basic ethics textbook; see especially the most widely used text, Frederick Copleston, A History of Philosophy (New York: Image Books/Doubleday, 1993). Specifically addressing the possibility of a "neutral ethics" in bioethics see Irving, "Quality Assurance Auditors: Between a Rock and a Hard Place", Quality Assurance: Good Practice, Regulation, and Law (March 1994), 3(1):33-52; Irving, "Which Ethics for Science and Public Policy?", Accountability in Research (1993), 3(2-3):77-99; Irving, "Which Ethics for the 21st Century? A Comparison of 'Secular Bioethics' and Roman Catholic Medical Ethics", Linacre Quarterly (in press); Irving, "Science, Philosophy and Expertise: An Evaluation of the Arguments on 'Personhood'", Linacre Quarterly (Feb. 1993), 60(1):18-46; Irving, "Maryland State Proposed Statute for Research Using 'Decisionally Incapacitated' Human Subjects: The Legalization of Normative Bioethics Theory", Accountability in Research (in press). [Back]

3 See, e.g., Tom Beauchamp and James Childress, Principles of Biomedical Ethics (New York: Oxford University Press, 1979), pp. 7-9; also, Tom Beauchamp and LeRoy Walters (eds.), Contemporary Issues in Bioethics (Belmont, CA: Wadsworth Publishing Company, Inc., 1982), pp. 1-3. [Back]

4 See note 2 supra. See also Dianne N. Irving, "The Woman and the Physician Facing Abortion: The Role of Correct Science in the Formation of Conscience and the Moral Decision Making Process", Proceedings of the Scientific Congress, The Guadalupan Appeal: "The Dignity and Status of the Human Embryo", Mexico City, October 28-29, 1999, Libreria Editrice Vaticana (in press), also in Linacre Quarterly November 2000); Irving, "NIH Human Embryo Research Panel Revisited: What is Wrong With This Picture?", Linacre Quarterly (May 2000); 67:2:8-22; Irving, "Individual Testimony Before the NIH Human Embryo Research Panel - March 14, 1994", reprinted in Linacre Quarterly (Nov. 1994), 61(4):82-89; Irving, "Embryo Research: A Call for Closer Scrutiny", Linacre Quarterly (July 17), 1994. See also, Wesley J. Smith, Culture of Death: The Assault on Medical Ethics in America (San Francisco, CA: Encounter Books, 2000); Smith, "Is Bioethics Ethical?" Weekly Standard (April 3, 2000), pp. 26-30; Smith, "The Deadly Ethics of Futile Care Theory," Weekly Standard (November 30/December 7, 1998), pp. 32-35; Ruth Shalit, "When We Were Philosopher Kings", The New Republic (April 28, 1997). [Back]

5 The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research; U.S. Department of Health, Education and Welfare (Washington, D.C.: Government Printing Office, 1978). [Back]

6 See Albert R. Jonsen, The Birth of Bioethics (New York: Oxford University Press, 1998), p. 295. Unless otherwise noted, all further references to "Jonsen" are to this book. Jonsen notes that because of the Roe v. Wade decision, "abortion, ancient moral question that it is, faded from the agenda of bioethics" (p. 295). This left those interested and involved in this most basic of life issues operating "on another planet", and fairly oblivious to the other life issues at stake within the bioethics community. (I will attest that in my 60 graduate course hours for my doctorate in the Department of Philosophy, and in the Kennedy Institute of Ethics, at Georgetown University, the issue of abortion was very rarely raised.) [Back]

7 These and other secular bioethics issues have been addressed at great length using predominantly the bioethics principles by secular bioethicists since the beginning of the field -- especially in such classic secular bioethics journals as The Hastings Center Report; The Journal of Medicine and Philosophy; The Journal of Clinical Ethics; Bioethics News; The Journal of Law and Medicine; Law, Medicine and Health Care; American Journal of Law and Medicine; The Kennedy Institute of Ethics Journal; Bioethics; Medical Humanities Review; Cambridge Quarterly of Healthcare Ethics; Christian Bioethics; Journal of Religious Ethics; Philosophy and Public Affairs; etc. (See Jonsen, p. 414). There now exists an entire library containing these bioethics articles, books and archives -- i.e., The Kennedy Institute of Ethics National Reference Center for Bioethics Literature, at Georgetown University, much of which is on the software BioethicsLine (which is plugged into the NIH National Library of Medicine, and to bioethics centers around the world). The arguments from these bioethics journals, books, etc., also have been continuously applied for over 30 years to "ethics" issues in other fields, e.g., medical research, law, business, engineering, religion, politics, education, military ethics, etc. -- and then extended to international issues. [Back]

8 National Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services (Washington, D.C.: United States Catholic Conference, Inc., 1995); these directives are supposed to be made known by Catholic health care institutions and followed by "the sponsors, trustees, administrators, chaplains, physicians, health care personnel, and patients or residents of these institutions and services.", p. 2. See also The Pontifical Council for Pastoral Assistance, Charter For Health Care Workers (Boston: St. Paul Books and Media, 1995). [Back]

9 See, Humanae Vitae (Boston: Pauline Books & Media, 1968): "It is, in fact, indisputable, as our predecessors have many times declared, that Jesus Christ, when communicating to Peter and to the apostles His divine authority and sending them to teach all nations His commandments, constituted them as guardians and authentic interpreters of all the moral law, not only, that is, of the law of the Gospel, but also of the natural law, which is also an expression of the will of God, the faithful fulfillment of which is equally necessary for salvation." (p. 2; emphases mine); the National Conference of Catholic Bishop's, Ethical and Religious Directives for Catholic Health Care Services: "The moral teachings that we profess here flow principally from the natural law, understood in the light of the revelation Christ has entrusted to his Church." (p. 2; emphases mine). See generally, Thomas Aquinas, Summa Theologica, IaIIae, q.94, Fathers of the English Dominican Province (trans.) (Westminster, MD: Christian Classics, 1981); Austin Fagothey, Right and Reason (3rd ed. only)(St. Louis, MO: The C.V. Mosby Company, 1963); Vernon Bourke, Ethics (New York: The Macmillan Company, 1953); Ralph McInerny, Ethica Thomistica (Washington, D.C.: The Catholic University of America Press, 1982). [Back]

10 The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, The Belmont Report: Ethical Principles and Guidelines for the Protection of Human Subjects of Research; U.S. Department of Health, Education and Welfare (Washington, D.C.: Government Printing Office, 1978). [Back]

11 Albert R. Jonsen, The Birth of Bioethics (New York: Oxford University Press, 1998). Unless otherwise noted, all further references to "Jonsen" are to this book. I acknowledge with great appreciation my extensive use of Dr. Jonsen's vast historical accounting of the history of bioethics as well as his extraordinarily detailed references as catalogued in this book. Another excellent recent book describing the history of bioethics is by David J. Rothman, Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making (New York: BasicBooks; a subsidiary of Perseus Books, L.L.C., 1991). Rothman's history also focuses on issues specific to scientific medical research. [Back]

12 Jonsen, p. 406. [Back]

13 Ibid., p. 6. [Back]

14 Ibid., p. 7. [Back]

15 Ibid., p. 7. [Back]

16 Ibid., pp. 7-8. [Back]

17 Ibid., p. 8. [Back]

18 Ibid., p. 11; see Rothman's book (note 11, supra) for a more focused history of the development of the scientific research issues that were simultaneously evolving. [Back]

19 Jonsen, p. 11. [Back]

20 Ibid., pp. 13-19. [Back]

21 S. Marsh Tenney, "Opening Assembly," from the Dartmouth Convocation on Great Issues of Conscience in Modern Medicine (September 8-10, 1960), published in Dartmouth Alumni Magazine 53(2) (1960):7-8; Jonsen, p.13. [Back]

22 Rene Dubos, Mirage of Health: Utopias, Progress and Biological Change (New York: Harper and Row, 1959); Jonsen, p. 13. [Back]

23 Jonsen, p. 13. [Back]

24 See, e.g., Mahomedali Currim Chagla (Indian Ambassador to the United States): "[O]ne of the most important issues of conscience in modern medicine" is that it increases population among the most impoverished, in "Address to the Evening Assembly," in Dartmouth Convocation on Great Issues of Conscience in Modern Medicine, note 21 supra, in Jonsen, note 40 p. 30; see also Jonsen, pp. 13-14. [Back]

25 Ibid., Dartmouth Convocation on Great Issues of Conscience in Modern Medicine, pp., 8, 9; Jonsen, p. 14. [Back]

26 Ibid., pp. 24, 37; Jonsen, pp. 14-15. [Back]

27 In Jonsen, p. 15 [and in note 44, p. 31: "Sir Julian Huxley, 'The future of man -- evolutionary aspects,' in Wolstenholme, Man and His Future, pp. 20-22"]. Jonsen also notes that "Huxley acknowledges his debt to the Jesuit anthropologist and theologian, Pierre Teilhard de Chardin, whose similar views about evolution to the 'noosphere' were then fashionable. See de Chardin's The Phenomenon of Man (New York: Harper and Row, 1959)." [Back]

28 J.B.S. Haldane, "Biological Possibilities for the Human Species in the Next Ten Thousand Years", in Wolstenholme, Man and His Future, p. 354; also Jonsen, p. 16. [Back]

29 Jonsen, p. 17. [Back]

30 Francis Crick, "Discussion: Ethical Considerations," in Wolstenholme, Man and His Future, p. 380; also Jonsen, p. 16. [Back]

31 Ramsey's verbal combat with eugenicists such as Muller, Lederberg and many others during this period are particularly well expressed in his book, Fabricated Man: The Ethics of Genetic Control (New Haven: Yale University Press, 1970). [Back]

32 James M. Gustafson, "Christian Humanism and the Human Mind," in John D. Roslansky (ed.), The Human Mind. A Discussion at the Nobel Conference (Amsterdam: North Holland Publishing, 1967), pp. vii, xix, 96; James Gustafson, "Basic Ethics Issues in the Biomedical Fields," Soundings (1970), 53:151-180, reprinted in Gustafson, Theology and Christian Ethics (Philadelphia: Pilgrim Press, 1974), p. 247; also Jonsen, pp. 17, 239-240. [Back]

33 See notes 2 and 4 supra. [Back]

34 Jonsen, pp. 17-18. [Back]

35 Daniel Callahan, "The Sanctity of Life", in Donald R. Cutler (ed.), Updating Life and Death: Essays in Ethics and Medicine (Boston: Beacon Press, 1969), pp.181-251. [Back]

36 Mary Meehan's interview with Daniel Callahan, in "Eugenics: Still Alive and Well", National Catholic Register, August 8, 1993. In recent years the name of the American Eugenics Society was changed to the American Society for Socio-Biology. [Back]

37 Jonsen, pp. 20-21. [Back]

38 Ibid., p. 22. [Back]

39 Ibid., pp. 23-24. [Back]

40 Ibid., pp. 23-24. [Back]

41 Ibid., p. 26. [Back]

42 Ibid., p. 25. [Back]

43 As Jonsen notes, by the end of the decade a small library of conference proceedings and collections of essays had accumulated. E.g., "Dr. J. Russell Elkington prepared three articles entitled, 'The literature of ethical problems in medicine', which appeared in the Annals of Internal Medicine 73 (1970):495-497; 662-666; 863-869. The literature review covered population control, contraception, abortion, eugenics, genetic counseling, genetic engineering, experimentation, use of artificial and transplanted organs, care and prolongation of life in the dying, definition of death, and euthanasia. In 1970 another extensive bibliography was compiled by James Carmody: Ethical Issues in Health Services: A Report and Annotated Bibliography (Washington, D.C.: Department of Health, Education, and Welfare [DHEW], 1970). The articles cited in both bibliographies were largely lectures and reports from the conferences of the decade. Then years later, Christine Cassel, Bernard Lo, and Henry Perkins prepared, 'The ethics of medicine: An annotated bibliography', Annals of Internal Medicine 92 (1980):136-141", in Jonsen, note 29, pp. 31-32. [Back]

44 U.S. Senate Subcommittee on Government Research, Committee on Government Operations, Hearings on S.J. Resolution 145, 90th Congress, 2nd session, March 8-9, 21-22, 27-28, April 2, 1968, pp. 1-3; see David J. Rothman, Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making (New York: Basic Books, 1991), Chapter 9; Jonsen, pp.90-91. [Back]

45 Jonsen, pp. 91-94. [Back]

46 Ibid., p. 91-94. [Back]

47 Victor Cohen, "Live Fetal Research Debated," Washington Post (April 10, 1973), A1, A9. One official of this NIH study group commented, "I don't think it is unethical. It's not possible to make this fetus into a child, therefore we can consider it as nothing more than a piece of tissue", in Jonsen, p. 94. [Back]

48 Cohen, "Scientists and Fetal Research," Washington Post (April 15, 1973), A1; Cohen, "NIH Vows Not to Fund Fetus Work," Washington Post (April 13, 1973), A1, A8. According to John C. Fletcher (who supports such research), "the demonstration at NIH was triggered by an experiment in Finland in which researchers perfused the heads of eight fetuses after hysterotomy to learn if the fetal brain could metabolize ketone bodies. This study was the only way by which the researchers could confirm findings from animal research", referring to the published study of P.A.J. Adam et al "Cerebral Oxidation of Glucose and D-BOH Butyrate by the Isolated Perfused Fetal Head", Pediatric Research, (1973), 7:309 - abstract. Fletcher also recounts another "strictly utilitarian investigative research study designed to increase biomedical knowledge but not to benefit the fetus involved": a 1963 study done after hysterotomy in which "U.S. scientists immersed 15 still-living fetuses in salt solution to learn if they could absorb oxygen through their skin. One fetus survived for 22 hours. The knowledge gained by the experiment contributed to the design of artificial life-support systems for premature infants", referring to the published study of R.D. Goodlin, "Cutaneous respiration in a fetal incubator", American Journal of Obstetrics and Gynecology (1963), 86:571-579 [in NBAC commissioned paper by John C. Fletcher, "Deliberating Incrementally on Human Pluripotential Stem Cell Research", [http://bioethics.gov/stemcell2.pdf], note 77, p. E-40]. Also note the Senate hearings on fetal research during the same time in which similar research experiments were explained and defended: FETAL RESEARCH: Hearing before the Subcommittee on Labor and Public Welfare; United States Senate; 93rd Congress, Second Session; "On Examination of the Varying and Somewhat Controversial Issues Involved in Regard to the Ban on Fetal Research Contained in the National Research Act; July 19, 1974 (Washington, D.C.: U.S. Government Printing Office). [Back]

49 Jonsen, p. 94. [Back]

50 Ibid., pp. 96-98. [Back]

51 Ibid., pp. 97-98. [Back]

52 The National Research Act, Public Law 93-348, 93rd Congress, 2nd session (July 12, 1974); 88 STAT 342; Jonsen, pp. 94-98, 333. [Back]

53 Jonsen, p. 98. [Back]

54 Ibid., pp. 325-351. [Back]

55 The National Commission was established by Title II of The National Research Act (Public Law 93-348), note 52 supra. [Back]

56 Jonsen, p. 100. [Back]

57 Members and staff of the National Commission are listed in all 10 their reports, e.g.: Research on the Fetus (Washington, D.C.: Government Printing Office, 1975): Federal Register vol. 40, no. 154 (1975): 33526-33551; Research Involving Prisoners (1976); Research Involving Children (1977); Research Involving Those Institutionalized as Mentally Infirm (1978); Psychosurgery (1977); Institutional Review Boards (1978); Disclosure of Research Information (1977); Delivery of Health Services (1988); the Special Study (1978); and The Belmont Report (1979). The papers and records of the National Commission and the President's Commission are maintained at the Kennedy Institute of Ethics National Reference Center for Bioethics Literature, Georgetown University, Washington, D.C. [Back]

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