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Topic: Religion
October 13, 2014 | Posted By Wayne Shelton, PhD

As I have been saying in recent blogs, most of what we do in clinical ethics, but also in most areas of bioethics, is procedural ethics. That is when we are faced with an ethical dilemma, our approach, whether consciously or unconsciously is usually to try to reach a reasonable compromise or consensus among the key participants that are in conflict consistent with well-established values and principles. This tendency reflects an obvious reality about the nature of contemporary ethics that we often ignore: in the current Western moral setting, our only viable methodology for resolving value laden disputes, whether at the micro level in clinical ethics or macro level in healthcare policy, is to attempt to craft an agreement or consensus among those with a say. Whether we are dealing with patients and families at odds with their physician on how to define the goals of care in the hospital setting or trying to build a consensus of opinion among voters in the political arena, we assume there are no final, authoritative moral answers that avail themselves to us. Whether we like it or not, we humans must figure out ethical dilemmas for ourselves and learn to get along.

Yet the idea of procedural ethics remains very worrisome for many people, including such bioethicists and Tristram Engelhardt, Jr. He believes that procedural ethics, such much of what we do in clinical ethics, is not really ethics in because it is based on convention and legalistic type standards. For him ethics worthy of the name must flow from a content-rich, canonical moral tradition that provides moral authority to our everyday ethical and moral judgments. The prototype ethical tradition was the medieval Christian Natural Law perspective grounded in Aristotelian philosophy. Aristotle assumed the inherent order and intelligibility of the cosmos, which also permeated his understanding of ethics. Humans, like all natural things, had a natural function, which was to be rational. But rational did not mean to that ethics was about finding intellectual or theoretical basis for right action according to rational rules in order to know and perform one’s duty—this was Kant’s (1724-1804) ethics during the 18th century following the rise of modern science. For Aristotle, the question was, how can one live and embody the good life; so rationality in this sense meant internal harmony between emotions and decision-making that resulted in well-established habits or states of character. This means finding in all of one’s activities the balance between excess and deficiency, or what he called the “mean”. Over time, forming the right habits according to the mean in all areas of life lead to excellence and happiness or what he called the good life. This was the natural fulfillment of the human function in practical terms consistent with the ancient Aristotelian.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website

September 9, 2013 | Posted By Marleen Eijkholt, PhD

Sarah is 10 years old and has cancer. She has lymphoblastic lymphoma, an aggressive form of non-Hodgkin lymphoma. News reports suggest that her parents and Sarah herself, decided to stop chemo treatment. “Sarah’s father said she begged her parents to stop the chemotherapy and they agreed after a great deal of prayer”. Sarah and her family are Amish. Reports note that they refused chemobecause the side effects made Sarah horribly sick, and that she was worried about losing her fertility. They decided to use a doctor who would attempt to treat the cancer with natural medicines, like herbs and vitamins. 

Over the last couple of days, their court battle has been outlined in the media. The hospital, where Sarah had been treated with chemotherapy, had applied for limited guardianship.  Guardianship would allow them to ‘force’ chemo therapy on her, particularly as they estimated her chance of long-term survival around 85% after treatment. Initially, this guardianship request was refused on grounds that it was the parents’ right to end treatment, while on appeal the judge ruled her best-interest had to be reconsidered. However, the most recent judgment reasoned that the parents were concerned and informed, that they have a right to decide about treatment for their child, that there was no guarantee for success of the chemo, and that guardianship & treatment would go against the girl’s wishes as it could cause her infertility. Guardianship was refused; Sarah’s health is governed by her parents.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

August 26, 2013 | Posted By Marleen Eijkholt, PhD

Circumcision has been on my radar in different ways during my training as a health lawyer/bioethicist. Mostly, the issues presented in the form of ethical controversy about female circumcision; is it a form of mutilation or suppression of women on cultural/religious grounds?; as a tensions between religion, culture and resources, and sometimes in the form of questions around legality. However, these encounters were theoretical, and mostly based on extreme examples, interesting but abstract. When I saw a neonatal male circumcision (infant male circumcision: IMC) in my rounds through the hospital as a clinical ethicist, thoughts about the topic of circumcision revived even though this was male circumcision.

Witnessing this IMC, I observed the medical procedure, I saw that there were no parents at the bedside and that the child hardly cried on the sugar drip. This clinical picture was not what I expected. I never expected circumcision as such a routine procedure, seemingly performed without ritual or cultural significance at the bedside. My cultural bias took over, wondering why such an invasive procedure would be performed on a young child without capacity to consent, even though I also witnessed that the child hardly noticed it. Asking the physician about the reasons for it, he referred to the AAP statements, suggestions about health benefits, and to the fact that it is very common in America and mostly done: ‘because this is what Dads looks like’, without much thought.  Looking into the issue, I found acontemporary discussion regarding controversies about male circumcision, cultural biases and evidence based practices. I imagined and asked myself: how would I advise if I received a consult request about IMC? How should I conceive of right and wrong, also in the face of controversial evidence based studies? Especially since even the AAP encourages readers to “draw their own conclusions” (about the technical report and the primary resources). How can I assess this practice?

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.


October 10, 2012 | Posted By Wayne Shelton, PhD

The modern era in the West marks the beginning of a new way of understanding the purpose of a social system and how people fit in to it. The transition to the modern world was from a medieval world that was perceived to have inherent ends and truths, based on Aristotelian metaphysics and Catholic moral theology, that provided authoritative answers to fundamental questions about the nature of ultimate reality, knowledge, human nature and morality. In Europe during the 15th and 16th centuries, the radical political turmoil, stemming from the Protestant Reformation, and a growing sense of the rights of humans were leading philosophers like Hobbes (1588-1679), Locke (1632-1704) and Rousseau (1712-1778) to articulate a fundamentally new type of social and political system. Instead of the divine rights of kings to assert complete rule over subjects, which created an obligation for subjects to obey those divine rights, there emerged the concept that the social and political order should be structured so as to protect and preserve the natural rights of human beings qua citizens. This new understanding of how to understand society and individuals—later called social contract theory—provided the conceptual underpinnings of the eventual emergence of democratic systems: The idea that the social system should be structured in a manner so as to allow individual citizens to be free to live according to their life goals and values within the limits of respecting those same rights of others. This meant that individual citizens should agree to give up some of their rights, e.g. to steal and kill, for the larger benefit of living safely and in a manner of one’s own choice. 

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit ourwebsite.

July 12, 2012 | Posted By Wayne Shelton, PhD

Those of us who work in clinical ethics focus most of our intellectual energy on addressing ethical dilemmas in individual cases. Clinical ethics allows little time for armchair reflection. The urgent cases presented to us require fairly quick decisions. That is, if we are to be helpful, we have to find thoughtful ways to analyze ethical questions and reach prudent recommendations. But even for clinical ethicists, it is worthwhile from time to time to take a step back and consider the historical philosophical context in which we work and the challenges it poses for ethical reflection and judgments.

Clinical ethics has been criticized by some not having an adequate basis on which to give substantive answers to pressing ethical questions in medicine. I want to show how this concern is not only, not a problem, but is a sign of progress. First a little background about the state of contemporary western ethics as expressed in one of the most important critiques of philosophical ethics and morality in the past 100 years.

In his 1981 work entitled After Virtue, Alasdair McIntyre claims the actual moral world in which we live is in “a state of grave disorder”. The concepts and terms we use in contemporary ethical discourse, he believes, are nothing more than fragments of prior conceptual schemes that have largely lost their moral import. Even worse, we use ethical discourse in talking about obligation, rights and duties without fully realizing the lost moral orders in which these words once had their original meaning. This is a concerning charge for clinical ethicists since much of our daily work involves using just these kinds of terms. Do we have a clear grasp of what our moral terms mean and how they are being used?

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

February 20, 2012 | Posted By Posted By David Lemberg, M.S., D.C.

Contraception, women's rights, and religious freedom have dominated the headlines in recent weeks. New guidelines require new health insurance plans to fully cover women's preventive health services, including the provision of birth control pills without co-payments. The administration estimates that by 2013, 34 million American women aged 18 to 64 will receive the benefits specified in the new ruling. Naturally (also, sadly), considering that this is the United States, a firestorm of ill-will began gathering in response. Lately the anti-contraception forces have been in full cry.

The rights of women to a full range of preventive health services are the main concern of the new guidelines. Women's health requirements are not the same as those of men. Also, if we take a breath and step back from this latest manifestation of America's highly destructive "culture war", we might notice that this entire argument could be avoided by instituting a single-payer health care system.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

September 23, 2011 | Posted By Posted By David Lemberg, M.S., D.C.

Dr. Michael Minor is the director of the H.O.P.E. Health Initiative for the Congress of Christian Education of the National Baptist Convention and undershepherd of the Oak Hill Baptist Church in Hernando, MS. Dr. Minor is a local, regional, and national champion of faith-based health and wellness mobilization. He is chairing the upcoming state-wide conference, Healthy Congregations Mississippi, planned for October 7-8, 2011.

In our wide-ranging interview, Dr. Minor discusses

  • How faith-based organizations are able to impact community health and wellness
  • Developing a community calendar of health observances and activities
  • Community action focusing on childhood obesity, nutrition, and diabetes
  • Creating health-and-wellness vacation Bible schools
  • New programs for sickle cell sabbaths
  • The need to focus on senior health and wellness

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.


August 3, 2011 | Posted By Michael Brannigan, PhD

What comes to mind when we think of ethics?

Problem-solving? Decision-making? Pondering, "What is the right thing to do"? "How am I to act"?

Herein lies the persistent hazard for ethics, particularly as an institutionalized field: its near-obsession with "the problem."

To explain, I first offer two senses of ethics. First, it is the formal philosophy and theology discipline that I've been trained in, together with other humanities and science courses. Second, it is an applied field, like my work in health care ethics, and more thoroughly institutionalized.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.


May 16, 2011 | Posted By Posted By David Lemberg, M.S., D.C.

A bioethicist, obviously, is a person who practices bioethics. But what does this entail? On one hand, bioethics could be narrowly construed as focusing on medical ethics. A broader perspective exists, based on an expansion of bioethics to "biological ethics". Both frameworks, the narrow and the broad, are eminently valid and neither needs to exclude the other.

The need for bioethics and bioethicists is greater now than ever. Bioethicists are able to offer substantial value to communities at all levels, ranging from the level of the individual (a community of one) to the level of the planet (a global community), conceived as an intricately interwoven biosphere.

Let's get specific. What are the kinds of things that bioethicists do?

A bioethicist could be a member of a hospital staff and function as a clinical consultant. Bioethics consultations facilitate patient care in

  • Determining capacity/competency related to making an informed choice
  • End-of-life planning and decision making
  • Determinations of medical futility
  • Assisting families in making decisions regarding withdrawal of life support

A bioethicist may also function as an ombudsman for the patient and family, helping to establish ongoing clear and effective communication among all concerned parties. Depending on the context and the need, she would consult with the patient, the patient's family, medical staff, and administrative personnel.

In such a practice, the bioethicist is applying daily the principles of autonomy, beneficence, nonmaleficence, and justice. He is engaged in rewarding, exciting, ever-changing work with real people grappling with real, life-impacting challenges. Every day presents new opportunities to help make a meaningful difference at an individual, family, and community level.

And, much more is possible. Bioethics need not be restricted to the medical arena. Looking beyond the world of hospital practice, there are an abundance of opportunities for the bioethicist to paint with a broader brush.

For example, what are the responsibilities and accountabilities of global pharmaceutical companies? Almost 3 billion people worldwide live on less than $2 per day. These persons do not have the wherewithal to afford life-saving medications. The pharmaceutical giants are very glad to conduct clinical trials in developing nations where the costs of doing business are substantially lower than in their home countries. But these companies do not reciprocate and provide drugs at cost to indigent communities and societies. Bioethicists can help create policies focusing on distributive justice to be implemented by multinational pharmaceutical corporations.

The fields of wildlife conservation, sustainability, and renewable resources could all be enhanced by bioethics-informed policy. Human health and welfare depend not only on our interactions with each other. If bioethics intends to support the thriving of humans, it necessarily intends to support the thriving of redwood forests, coral reefs, butterflies and bumblebees, songbirds, and tuna and salmon. Natural capital and ecological services are valued at many trillions of dollars annually. Each of the four iconic bioethical principles is intimately related to maintenance and support of our natural world.

Bioethicists may work in universities, hospitals, all levels of government, policy institutes, and NGOs. Importantly, bioethicists could also work in corporations. What sort of corporation—national or multinational—would hire a bioethicist? If the corporation’s sole interest is its bottom line, i.e., profit and shareholder dividends, bioethics would most likely not fit into its strategy.

But a corporation’s board could have a different vision. Such a board could understand that the organization's long-range welfare is closely tied to the global economy, which is closely tied to the welfare and productivity of all populations, which is closely tied to ensuring the ongoing viability of environmental resources and ecological services. Such a corporation’s goals would be greatly furthered and assisted by having bioethicists on staff.

Too often, an observer of the field gets the impression that bioethics is primarily concerned with parsing ever finer notions of patient autonomy. On this view, it is IRBs rather than angels which are dancing on the head of a pin. Switching metaphors, such navel-gazing helps no one, except to provide meager support for struggling academic careers.

Bioethics is not this. Bioethics is the broad end of the funnel. Almost 50 years ago in his famous book Love and Will, the American psychologist Rollo May described the transitional nature of then-modern 1960s society. Those transitional qualities have persisted rather than resolved. The global economy is in crisis. Global climate change is apparent. Environmental resources and species diversity are at great risk. Health care, as such, is unrecognizable compared to 50 years ago, and not in a good way.

Bioethics and bioethicists can provide unique perspectives and original solutions in helping resolve the diverse challenges facing not only the United States but our global society. Bioethics and bioethicists can participate fully and become critical assets in humanity's search for meaning, self-realization, and discovery of arete.

The Alden March Bioethics Institute offers graduate online masters in bioethics programs. For more information on the AMBI master of bioethics online program, please visit the AMBI site.

December 23, 2010 | Posted By John Kaplan, PhD

There are some strange things going on in Phoenix Arizona between St. Josephs Hospital and Bishop Thomas Olmstead. The scenario began in November 2009 when the pregnancy of a woman with malignant pulmonary hypertension was terminated to save her life. At that time the Bishop responded by excommunicating a member of the ethics committee which had authorized the procedure. Fast forward to November 22, 2010 when Bishop Olmstead sent a letter (read it here) to the President of Catholic Healthcare West, St. Joseph’s parent corporation threatening to strip St. Joseph’s of their Catholic identity unless they concurred with several conditions that include acknowledgement that they were wrong and he is right.  Click on the picture of St. Joseph's below to see coverage.


Read the letter-the hubris is palpable. Now the Bishop has followed through on his threat and St. Joseph’s has stated it could not ethically and legally comply with the Bishop’s demands. Essentially the Bishop has behaved as a bully and taken the position that you either play my way or I will take my ball and go home. Now he has taken the ball. Fortunately St. Joseph’s, the largest teaching hospital in Arizona and a significant provider of care for the poor and indigent seems poised to continue without the Bishop.

BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.