Common Morality, Human Rights, and Multiculturalism in Japanese and American Bioethics

To address some questions in global biomedical ethics, three problems about cultural moral differences and alleged differences in Eastern and Western cultures are addressed: The first is whether the East has fundamentally different moral traditions from those in the West. Concentrating on Japan and the United States, it is argued that theses of profound and fundamental East-West differences are dubious because of many forms of shared morality. The second is whether human rights theory is a Western invention with no firm traditions in Eastern moral traditions. It is argued that this thesis is unsupported both historically and in contemporary bioethics. The third problem is whether multiculturalist theory casts doubt on claims of universal principles and rights. It is argued that the reverse is true: multiculturalism is a universalistic theory. The argument throughout supports common morality theory

Principals and Other Emerging Paradigms in Bioethics

Symposium:Emerging Paradigms in Bioethic

Principals and Other Emerging Paradigms in Bioethics

Symposium:Emerging Paradigms in Bioethic

Principialismo bioético e biolegal: a bioética e o biodireito precisam de um novo arcabouço de princípios?

Toe four principies of biomedical ethics are widely used in the world for bioethical deliberation. Therefore, it is understood that these theoretical guides are useful for the analysis and resolution of particularly complex ethical controversies arising in clinical and biomedical fields. This paper unfolds an analysis of the basic universal principies, the common universal morality, and sorne features of each principie. Toen it discusses sorne problems posed by critics of European biolaw who have provided alternative frameworks of principies that are nonuniversal to culture. Finally, it shows how universal moral principies are connected to human rights, how rules and rights are specified to become detailed and practical for certain moralities, and how these ideas are connected with problems of justification in bioethics and biolaw.Los cuatro principios de la ética biomédica se utilizan ampliamente en el mundo para la deliberación bioética. Por tanto, se entiende que estas guías teóricas son útiles para el análisis y resolución de controversias éticas particularmente complejas que surgen en el campo clínico y biomédico. Este artículo desarrolla un análisis de los principios universales básicos, la moral universal común y algunas características de cada principio. Luego, analiza algunos problemas planteados por los críticos del bioderecho europeo que han proporcionado marcos alternativos de principios que no son universales a la cultura. Finalmente, se muestra cómo los principios morales universales están conectados con los derechos humanos, cómo se especifican las reglas y los derechos para que sean detallados y prácticos para ciertas moralidades, y cómo estas ideas se relacionan con problemas de justificación en la bioética y en el bioderecho.Les quatre principes de l'éthique biomédicale sont largement utilisés dans le monde pour les délibérations bioéthiques. Par conséquent, il est entendu que ces guides théoriques sont utiles pour l'analyse et la résolution de controverses éthiques particulierement complexes qui surgissent dans le domaine clinique et biomédica!. Cet article développe une analyse des principes universels de base, de la morale universelle commune et de certaines caractéristiques de chaque principe. 11 analyse ensuite certaines questions soulevées par les critiques du biodroit européen qui ont fourni des cadres alternatifs de principes qui ne sont pas universels pour la culture. Enfin, il montre comment les principes moraux universels sont liés aux droits de l'homme, comment les regles et les droits sont spécifiés pour étre détaillés et pratiques pour certaines morales, et comment ces idées sont liées aux problemes de justification en bioéthique et dans le biodroit.Os quatro princípios da ética biomédica sao amplamente utilizados no mundo para deliberac;:ao bioética. Portanto, entende-se que esses guias teóricos sao úteis para a análise e resoluc;:ao de controvérsias éticas particularmente complexas que surgem no campo clínico e biomédico. Este artigo desenvolve urna análise dos princípios universais básicos, a moralidade universal comum e algumas características de cada princípio. Em seguida, analisa algumas quest6es levantadas por críticos do biodireito europeu que forneceram estruturas alternativas de princípios que nao sao universais para a cultura. Finalmente, mostra como os princípios morais universais estao ligados aos direitos humanos, como as regras e direitos sao especificados  para serem detalhados e práticos para certas moralidades, e como essas ideias se relacionam com os problemas de justificac;:ao em bioética e na biodireito

GRUNDSATZE IN DER BIOETHIK

Pitanje moralnih problema u biomedicinskoj znanosti autor promatra sa stajališta utemeljenja moralnih načela kao pretpostavki moralnog djelovanja u medicinskoj praksi. Autor definira biomedicinska načela kao osnovne norme u sustavu normi određenih za moralno razmišljanje, s temeljnom zadaćom ukazivanja na moralno relevantna svojstva pojedinih okolnosti. Zato sustav biomedicinskih načela nije, niti može biti, sustav isključivo osobnih vjerovanja ili neobveznih normi. Podjela biomedicinskih načela, narav načela i potreba za njihovom specifikacijom središnji su dio članka. Tako autor dijeli biomedicinska načela u četiri grupe: 1. poštivanje autonomnosti (načelo koje zahtijeva poštivanje sposobnosti donošenja odluka samostojnih osoba), 2. neškodljivost (načelo koje zahtijeva da se drugima ne nanosi zlo), 3. dobročinstvo (skup načela koja zahtijevaju da spriječimo štetu, omogućimo dobrobit i odmjerimo dobrobit u odnosu na opasnost i cijenu) i 4. pravednost (skup načela koja zahtijevaju ravnomjernu i poštenu raspodjelu dobrobiti, opasnost i cijene).The question of moral issues in biomedical science is discussed by the author from the point of establishment of moral principles as prerequisites of moral action in medical practice. The author defines biomedical principles as the basic norms in a system of norms determined for moral contemplation, with the fundamental task of indicating morally relevant features of specific circumstances. Therefore, the system of biomedical principles is not, and cannot be, solely a system of personal beliefs and optional norms. The distribution of biomedical principles, the nature of these principles and the need for their specification is the central topic of this article. The author thus discerns four groups of blomedlcal principles: 1. consideration for autonomy (the principle which demands the respect of an independent person\u27s ability to make decisions), 2. harmlessness (the principle that prevents harm to be inflicted on others), 3. benefaction (a set of principles demanding the prevention of harm, enabling well-being and assessing well-being with regard to prospective danger and cost), and 4. justice (a set of principles demanding the equal and fair distribution of well-being, danger and cost).Ausgehend von der Position, daB mit der Grundlegung morelischer Prinzipien die Voraussetzungen zu moralischem Handein in der medizinisehen Praxis gegeben seien, untersucht der Verfasser die Frage moralischer Probleme in der biomedizinischen Wissenschaft. Die biomedizinischen Grundsatze werden als die Hauptnormen innerhalb eines zu moralischem Denken dienenden Normensystems definiert, deren Hauptaufgabe es ist, auf moraliseh relevante Eigenschaften einzelner Umstande hinzuweisen. Daher ist das System biomedizinischer Prinzipien keine Sammlung ausschlieBlich personIicher Ansichten oder unverbindIicher Normen und kann es auch nicht sein. Den zentralen Teil des Artikels bilden eine Unterteilung der biomedizinischen Prinzipien, die Beschreibung ihres Wesens und ihre Spezifizierung. Der Verfasser unterscheidet so vier verschiedene Gruppen biomedizinischer Grundsatze: 1. Respektierung der Autonomie (Forderung nach Respektierung der Fahigkeit, selbstandig EntschlOsse zu fassen), 2. Unschadlichkeit (Forderung, anderen keinen Schaden zuzufOgen), 3. Wohltatigkeit (Gruppe von Grundsatzen mit der Forderung, Schaden zu verhindern, Wohl zu ermoglichen und dieses am Verhaltnis zu Risiko und Preis zu messen) und 4. Gerechtigkeit (Gruppe von Grundsatzen mit der Forderung nach gleichmaBiger und fairer Verteilung von Wohl, Risiko und Preis)

Hastened Death and the Regulation of the Practice of Medicine

We begin with a summary of the controversy over legalized assistance in hastening death and a description of how that controversy led to Gonzales v. Oregon. We then review the Gonzales decision, explaining what it did and did not resolve. Looking to how these issues should be analyzed in the future, we will explain why a fundamental distinction currently embedded in the law is unhelpful in analysis of the legitimacy of assistance in hastening death. We will argue that, correctly understood, assistance in hastening death is properly regarded as a medical practice, or, more broadly stated, that a physician legitimately may assist in various ways in helping to bring about the death of a terminally ill patient who has explicitly and competently requested this assistance from the physician. In making this argument, we suggest how these and other disputes over medicine’s boundaries should be resolved

Designing for Diabetes Decision Support Systems with Fluid Contextual Reasoning

Type 1 diabetes is a potentially life-threatening chronic condition that requires frequent interactions with diverse data to inform treatment decisions. While mobile technolo- gies such as blood glucose meters have long been an essen- tial part of this process, designing interfaces that explicitly support decision-making remains challenging. Dual-process models are a common approach to understanding such cog- nitive tasks. However, evidence from the first of two stud- ies we present suggests that in demanding and complex situations, some individuals approach disease management in distinctive ways that do not seem to fit well within existing models. This finding motivated, and helped frame our second study, a survey (n=192) to investigate these behaviors in more detail. On the basis of the resulting analysis, we posit Fluid Contextual Reasoning to explain how some people with diabetes respond to particular situations, and discuss how an extended framework might help inform the design of user interfaces for diabetes management

Neoadjuvant chemoradiation compared to neoadjuvant radiation alone and surgery alone for Stage II and III soft tissue sarcoma of the extremities

<p>Abstract</p> <p>Background</p> <p>Neoadjuvant chemoradiation (NCR) prior to resection of extremity soft tissue sarcoma (STS) has been studied, but data are limited. We present outcomes with NCR using a variety of chemotherapy regimens compared to neoadjuvant radiation without chemotherapy (NR) and surgery alone (SA).</p> <p>Methods</p> <p>We conducted a retrospective chart review of 112 cases.</p> <p>Results</p> <p>Treatments included SA (36 patients), NCR (39 patients), and NR (37 patients). NCR did not improve the rate of margin-negative resections over SA or NR. Loco-regional relapse-free survival, distant metastases-free survival, and overall survival (OS) were not different among the treatment groups. Patients with relapsed disease (OR 11.6; p = 0.01), and tumor size greater than 5 cm (OR 9.4; p = 0.01) were more likely to have a loco-regional recurrence on logistic regression analysis. Significantly increased OS was found among NCR-treated patients with tumors greater than 5 cm compared to SA (3 year OS 69 vs. 40%; p = 0.03). Wound complication rates were higher after NCR compared to SA (50 vs. 11%; p = 0.003) but not compared to NR (p = 0.36). Wet desquamation was the most common adverse event of NCR.</p> <p>Conclusions</p> <p>NCR and NR are acceptable strategies for patients with STS. NCR is well-tolerated, but not clearly superior to NR.</p

Democracy: the forgotten challenge for bioethics in the developing countries

<p>Abstract</p> <p>Background</p> <p>Bioethics as a field related to the health system and health service delivery has grown in the second half of the 20^thcentury, mainly in North America. This is attributed, the author argues, to mainly three kinds of development that took place in the developed countries at a pace different than the developing countries. They are namely: development of the health system; moral development; and political development.</p> <p>Discussion</p> <p>This article discusses the factors that impede the development of the field of bioethics from an academic activity to a living field that is known and practiced by the people in the developing countries. They are quite many; however, the emphasis here is on role of the political structure in the developing countries and how it negatively affects the development of bioethics. It presents an argument that if bioethics is to grow within the system of health service, it should be accompanied by a parallel changes in the political mindsets in these countries.</p> <p>Summary</p> <p>For bioethics to flourish in developing countries, it needs an atmosphere of freedom where people can practice free moral reasoning and have full potential to take their life decisions by themselves. Moreover, bioethics could be a tool for political change through the empowerment of people, especially the vulnerable.</p> <p>To achieve that, the article is proposing a practical framework for facilitating the development of the field of bioethics in the developing countries.</p