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May 2, 2011 | Posted By David Lemberg, M.S., D.C.

Bioethics Today — A Manifesto

The field of bioethics is in the right place at the right time. The right place is at the intersection of medical practice, health care delivery, health care policy, and development of clinical guidelines and standards of care. The right place includes bioengineering, nanotechnology, pharmaceutical R&D, and environmental conservation and sustainability. Bioethics concerns range far afield, encompassing reproductive medicine, regenerative medicine, stem cell research, and man–machine interfaces.

Bioethics investigates and explores the underpinnings, ramifications, and implications of democracy, human rights, freedom of the individual, the existence of free will, and the origins and implementations of moral and ethical systems.

The right time for bioethics is right now. The present moment. The great philosopher Arthur Schopenhauer wrote, "Future and past are only in the concept. . . . The present alone is the form of all life, but it is also life's sure possession which can never be torn from it."1

In short and in effect, bioethics focuses on being-in-the-world. That is a pretty big mandate. The practical result is that there is unlimited opportunity for innovation and development of outside-the-box solutions to real-world problems. For example, the health care system is desperate for impactful and visionary leaders. In the United States we have several dozen, possibly more. Yet the actual need is for hundreds, even thousands, of such leaders, operating in government, industry, higher education, health care delivery complexes, and non-profit policy centers.

Bioethical conundrums abound, including

  • The six-figure-plus annual costs of many cancer medicines
  • The ongoing lack of access to and availability of HIV medication in Africa and Southeast Asia.
  • Access and availability of health care services, worldwide
  • The moral status of the embryo and the ethics of embryonic stem cell research
  • End-of-life decision making
  • Prenatal genetic testing and counseling. Reproductive freedom, including IVF, same-sex parenting, and surrogacy

The world of bioethics is as big and broad, as deep and rich, as extensive and wide-ranging as the world we live in. The problems and challenges of humans (as the presumptive stewards of the planet) are the problems and challenges of bioethics. The historical four principles of bioethics—autonomy, beneficence, nonmaleficence, and justice—provide a firm foundation for this next generation of work to be done. These principles represent a launching pad for a new phase of endeavor. A phase in which bioethics can provide insight, guidance, and action steps to facilitate the thriving of all species, inclusive of our entire ecosphere.

1Schopenhauer A: The World as Will and Representation, Vol. 1, p 278. New York, Dover Publications, 1969

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.

3 comments | Topics: Doctor-Patient Relationships, End of Life Care, Philosophy, Genetics

Comments

Richard R. Pesce, MD, MS

Richard R. Pesce, MD, MS wrote on 05/04/11 2:16 PM

Congratulations on Bioethics Today and its mainfesto. I look forward to seeing the topics and action evolve on all fronts. More immediately, in clinical practice, the concept of the ACO and how it will impact end-of-life decision making needs to be explored. If Amercan practice does come to this model of care many, many difficult decisions will need to be made. Certainly the $90,000 prostate cancer drug recently approved by the FDA will most certainly be among the first of the expensive therapies to go at the end of life to go, as will prolonged stays for multiple system failure patients in the critical care unit. It is time for these conversations to occur, so let us begin them.
Michael Orenstein

Michael Orenstein wrote on 05/04/11 7:46 PM

There is no doubt that this is a bold and exciting contribution to an incredibly diverse and exciting field. Bioethics is uniquely situated at the crossroads between clinical medicine, basic science, philosophy, law, emerging technologies, social policy, and a host of other disciplines. David Lemberg is a dynamic person of broad experience, integrity, intelligence, and curiosity. I know him as a wonderful communicator and friend. Under his leadership, we can expect to be challenged and stimulated by this timely project.
Congratulations on Bioethics Today and it's audacious goals.
Michael Orenstein MD

Michael Orenstein MD wrote on 05/20/11 12:14 AM

I was in NYC on May 18 & 19, at the Warwick Hotel, for the Presidential Commission for the Study of Bioethical Issues. It was the focus of this meeting, the 5th in a series, to review whether Federal regulations, and international standards currently afford adequate protection of human subjects in research. This is being done in the light of the revelation that the U. S. Public Health Service conducted studies on sexually transmitted diseases in Guatemala from 1946-1948. The panel included an outstanding panel of experts in bioethics, law, philosophy,and multiple disciplines. Amy Gutman was the chair, and James Wagner the vice-chair. The Commission included an all-star lineup of bioethicists like Anita L. Allen, John D. Arras, Barbara F. Atkinson, Nita A. Farahany, Daniel P. Sulmasy, to name a few. These experts, as well as those who were interviewed were from academia, both domestic and international agencies, including both governmental and non-governmental ones. The sessions were divided as follows: 1) Review of existing Federal standards 2) Efforts to implement Federal standards; both U.S. and international efforts 3) Ethical issues pertaining to their implementation 4) Roundtable discussions 5) Comparison of Transnational standards (WMA),(CIOMS),(UNESCO),(GCPA),( EGA), and (BEPA).
In my view, the basic issue boils down to this: Does rigid compliance with regulations alone provide the greatest protection, or should greater educational efforts, focusing on application of ethical principles, form the crux of our wall of protections of human subjects? Other issues brought to light were the tightrope that one walks in deciding where the line is drawn between research that is too harmful to individuals, yet beneficial to society at large. Should the Belmont Report's "respect for persons" be more accurately interpreted as " respect for the rights of persons?" Clearly individuals who volunteer for medical research will not be the personal beneficiaries of those efforts. What are the justifications for choosing a particular group of subjects rather than another group, and how is the principle of justice adequately fulfilled? How can the concepts of justice, or exploitation even be defined? The subtle differences between "The Common Rule" in U.S. research, and the principles elaborated in codes like the Declaration of Helsinki, or other documents on medical ethics, may actually serve a very useful purpose that harmonization might not serve quite as well.That often overlooked benefit may be that the process of thinking about research ethics must remain an ongoing dialog, not confined to rigid application and conformance with regulations. A strictly legalistic approach to the protection of human subjects may not be the best way to protect against future episodes of unethical conduct in medical research.

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ABOUT BIOETHICS TODAY
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.
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