PHILOSOPHY SUMMER SCHOOL IN CHINA

2005 SESSION Huazhong University of Science and Technology, Wuhan

25 July – 12 August

BIOETHICS

Andrew Edgar (Cardiff University):

Meta Medical Ethics

The objective of this course is to explore a number of different approaches to the understanding and resolution of moral dilemmas in medicine.  We will raise questions about the source of our moral values, and about whether or not moral values can be considered to be cultural universals.  In effect, we will ask whether the grounding of Chinese bioethics needs to be different from American or European bioethics.  We will also ask about the possibility of holding rational moral debates about ethical questions, in particular during times of cultural change and uncertainty.  At all points in our discussions, we will illustrate our discussions by reference to concrete examples from medical ethics.

A dominant approach to bioethics is that of principlism.  Principlists argue that bioethical dilemmas can be approached in terms of four principles that can guide ethical action:  beneficence; non-maleficence; a respect for autonomy; and a concern for justice.  This course will begin by outlining principlism, and will examine its justifications and its origins in utilitarian and in Kantian philosophy.  The remainder of the course will look at criticisms to principlism and alternatives that have developed by European and American bioethicists over the last two decades.

The criticisms of principlism will begin by looking at casuistry.  Casuistry begins from individual examples (or cases) of ethical dilemmas, and seeking typically (or paradigm) cases.  Analogical reasoning form these paradigms to new cases informs ethical decision-making.  While principlism develops general principles that it then applies to particular cases, casuistry begins with the cases, in order to develop practical solutions to particular problems.  In the light of our examination of casuistry, we will ask whether principlism presupposes a realistic model of ethical decision-making.  This will also allow us to examine the relationship between ethical decision-making and legal decision-making.

The course will continue by exploring the degree to which our ethical decision-making depends upon the particular cultural contexts within which we develop as moral agents, and within which the moral dilemma occurs.  Communitarianism offers an insight into this problem, insofar as it stresses the communal aspect of our existence, in contrast to principlism's stress on individual autonomy (derived from Kant).  One the one hand, this allows us to ask about the role that communal interests and goals (as opposed to individual interests) should play in ethical decision-making.  On the other hand, we can begin to pose the question as to whether there are universal moral values, that ought to apply in all cultures, or whether moral values are culturally relative.

The next block of lectures will focus on approaches to bioethics that find their justification largely outside utilitarianism or Kantianism.  Hermeneutics and phenomenology focus upon the way in which human agents make sense of the world around them.  The implications that this has for medical ethics includes the recognition that a moral dilemma is not something that simply exists, independently of the human agents involved, but is rather something that is actively interpreted, negotiated and constructed by them.  This insight will allow us to look at the way in which dilemmas are understood and evaluated, and we can examine the sorts of skills and presuppositions that we bring to moral reasoning.  Narrative ethics and virtue ethics continue this approach.  Narrative ethics looks in particular at the stories that we tell about our own lives and the lives of others, and the place that experiences of acute and chronic illness may have in them.  Again, we can explore the degree to which the ability to tell stories helps in our understanding of the experience of illness and the moral dilemmas that occur in its treatment.  Virtue ethics explores the moral habits that we develop.  If hermeneutics and narrative ethics have some validity, then in the light of virtue ethics we can begin to ask about the sorts of moral habits and attitudes that we should cultivate, as patients, carers and as medical professionals, in order to be about to recognise and respond to moral problems.  Finally, in this block of lectures, discourse ethics allows us to examine the way in which moral dilemmas and moral values can be the subject of rational debate, and the conditions that must be in place in order to bring about a fair moral decision, to which all concerned will consent.

In the last two lectures, feminism and postmodernism will be used to summarise and deepen our understanding of what has already been addressed.  Feminist approaches to medical ethics explore the importance of women's experience of caring, and ask whether there are approaches to ethics that are more typical of women than of men.  Postmodernism looks at the problem of continuing to make valid moral decisions, and to act morally, in the absence of any uncontested and universally accepted moral values.

1.   Principlism – consequentialism (beneficence and non-maleficence)

2.   Principlism – Kant and rights (autonomy and justice)

3.   Casuistry and the law.

4.   Communitarianism and pluralism

5.   Phenomenology and Hermeneutics

6.   Narrative Ethics

7.   Virtue Ethics

8.   Discourse Ethics

9.   Feminism

10. Conclusion:  Medical Ethics in Postmodernism

Course book: Matti Hayry and Tuija Takala, Scratching the Surface of Bioethics, Amsterdam: Rodofi, 2003

Dr. Mairi Levitt (Lancaster University):

Social and ethical issues in human genetics

Advances in human genetic research and applications raise some of the most complex ethical and social issues in bioethics. In the course we will look first at the historical background which is still invoked in discussions of genetic research and applications in the US and Europe and has an influence on the mode of regulation.  We will then focus on specific applications of genetics and discuss their implications, engaging both with traditional bioethical concerns and with the wider social and political context. This will include questions about bioethics itself, for example, what sorts of things get defined as

'ethical problems'? Could bioethics sometimes be seen as a legitimating discipline for genetic researchers, the health care industry and the medical profession? What role, if any, should the general public have in these debates and in policy decision-making? Should particular attention be paid to the opinions of those affected by genetic disorders? In the final session we will speculate on possible futures in terms of how genetic research might affect health care and the type of society in which we live.

1.  Introduction: The historical background. Framing the debate. Ethical and social

     values

2.  Regulation of genetics:  genetic exceptionalism; precaution and permissiveness.

3.  Genetic screening and testing:  choice, the right to know and the right not to know,

     designer babies/chosen children

4.  Genetic counselling - the ideology of non-directiveness, informed consent, autonomy,

     risk

5.  Cloning and stem cells - commodification of life, 'playing god'

6.  Genetic databases (Biobanks)- confidentiality, privacy, trust, community vs individual 

     rights, benefit sharing

7.  Genes and behaviour - nature/nurture debate, genetic fatalism

8.  Crime and genetics - responsibility, justice, stigma and blame

9.  Disability  - discrimination, stigma, eugenics, defining normality

10.The future of genetics in health care

Course text: Selections from

Onora O'Neill: Autonomy and Trust in Bioethics

Alison Pilnick: Genetics and Society

Pre-reading: Pilnick: Chapter 1 for useful for basic information on genetics.

Professor Jeff McMahan (Rutgers University):

THE MORAL STATUS OF HUMAN BEINGS

In this course, I will discuss moral questions concerning fetuses, abortion,

embryonic stem cell research, infanticide, anencephalic infants, the

irreversibly comatose, the comparative status of animals and human beings with

comparable cognitive capacities, how our principles of justice and equality

apply in the case of severely cognitively impaired human beings, the morality

of screening for disability, and the alteration of human nature, particularly

through genetic enhancement. 

Course text: Jeff McMahan, The Ethics of Killing: Problems at the Margins of Life

Professor Dan Wikler (Harvard University):

ETHICS AND POPULATION HEALTH

The course will investigate ethical issues arising in consideration of

health at the population level. Among the issues are inequalities in health,

assigning responsibility for health, health resource allocation, and ethical

issues in health measurement.

Course text: selections from

Sudhir Anand, Fabienne Peter, and Amartya Sen, eds, Public Health, Ethics, and Equity (Oxford, 2005)

Daniel Wikler and Christopher Murray, eds, Health, Well-Being, Justice: Ethical Issues in Health Resource Allocation (forthcoming 2006) and other material.