Monsellier, R. Pottier, J. Thibert, J. Tissot, J. Vernant, C. Article Article Outline. Access to the text HTML. Access to the PDF text. Recommend this article. Save as favorites. Access to the full text of this article requires a subscription. If you are a subscriber, please sign in 'My Account' at the top right of the screen. Bioethics and the law: Should courts be allowed to make end of life decisions? Reflections on the Charlie Gard and Alfie Evans controversies. Outline Masquer le plan. The Charlie Gard case. The Alfie Evans case.
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The argument from civil order. The argument from liberal democracy. An objection: whose interests matter? Past abuses, futility, and autonomy in American bioethics. Disclosure of interest. Under the Texas law, hospital ethics committees first decide that care should be withdrawn and courts subsequently decide whether to overturn the hospital's decision.
Under the English and European system, the issue may be at an impasse and both parties turn to the court for a decision. For example, my choice to eat potato chips as a snack arguably harms the environment, health insurers who may one day need to pay for blood pressure medications on my behalf, and, to some extent, farmers who may be exploited by capitalist markets that fail to compensate them adequately. In moral and legal practice, the ethical calculus rarely extends that far.
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Rather, we are usually only justified in preventing individuals from pursuing actions that harm a specific person in a specific way without an overriding reason. Click here to see the Library ] and Cruzan v. Other countries quickly followed suit. Thus, funding bodies including not only the European Commission but also the Wellcome Trust had a significant impact in encouraging social science input. This has been defined by Rene von Schomberg as a transparent, interactive process by which societal actors and innovators become mutually responsive to each other with a view on the ethical acceptability, sustainability and societal desirability of the innovation process and its marketable products in order to allow a proper embedding of scientific and technological advances in our society.
Ethical acceptability is further explained here as being in compliance with the values of the European Union charter on fundamental rights, such as the right to privacy. Nigel Dower has drawn a distinction between an ethic that is global in application and an ethic that is global in acceptance.
What does it mean for an ethics to apply globally? A further distinction needs to be drawn between extending, say, discussions of the just distribution of healthcare resources from intrastate to the interstate arena on the one hand, and discussing issues that are global per se on the other. The latter include issues that of their very nature in principle affect the whole globe, as in the cases of climate change and global pandemics, or in discussions of the human genome as the common heritage of humanity.
In dealing with these issues the question arises as to whether theories of biomedical ethics that have been prominent in the west are adequate in other locations and contexts. Bioethicists have discussed whether Kantianism, utilitarianism, and virtue theory, for instance, can feasibly be applied on a global scale. Raanan Gillon has argued that autonomy, beneficence, non-maleficence and justice are the basis for a global ethics, being universally accepted in some form.
At the end of the 20th century and at the beginning of the 21st century there was a notable increase in attempts to move away from the dominance of individualistic thinking in bioethics, including the perceived pre-eminence of autonomy in the four principles. One reason for this was the development of biobank research, leading the World Health Organisation, for example, to say that the balance between the individual and collective needed to be rethought. In speaking of genetic databases they said … the justification for a database is more likely to be grounded in communal value, and less on individual gain … … it leads to the question whether the individual can remain of paramount importance in this context.
And the achievement of optimal advances in the name of the collective good may require a reconsideration of the respective claims so as to achieve an appropriate balance between individual and collective interests, including those of ethnic minorities, from a multi-cultural perspective. This has been described as a communitarian turn.
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It is unusual for the Council to issue reports on particular principles rather than on specific issues. The report explored the ways in which it might be applied. Solidarity comes in different guises. There are distinctions to be drawn between face-to-face and mediated solidarity as in an insurance company , between the solidarity of a coalition and humanitarian solidarity. The relationship between the communitarian turn and globalisation needs consideration. On the face of it, solidarity is associated with membership of groups or communities, and so might be thought naturally to combine with exclusion of the interests of those who are not members of the group.
The possibility of humanitarian solidarity, where the relevant group includes all human beings, is needed to counteract this potential problem.
The development of feminist bioethics was increasingly influential during the period. Following the establishment of the International Association of Bioethics in the early s, Feminist Approaches to Bioethics was established as an international network of feminist scholars. The work of feminist bioethicists had considerable impact upon bioethics worldwide. The concerns of feminist bioethics to some extent overlapped with those of communitarians and also extended to global issues.
The concept of relational autonomy, for example, emphasized the context of social relationships in which individuals exist, and provided a counter balance to the picture of the autonomous agent as an isolated individual decision maker. In the context of reproductive decision-making, whether concerning genetic testing or termination of pregnancy, the power of women to make a choice in relation to partners, clinicians and the prevailing legal system has to be taken into account.
As regards global issues, questions of the global distribution of healthcare resources cannot ignore the stark differentials between men and women in some societies, evident for example in sexual and reproductive health and infant mortality statistics. Idealized agents have traditionally been based on the model of men and are thus biased in favour of men.
These considerations, in turn, connect feminist, communitarian, and global approaches to the increasing emphasis on public health ethics during the past decade, with issues such as antibiotic resistance, climate change, and obesity now receiving far more attention in bioethics and beyond. But the extent to which this is a new phenomenon is debatable. They stemmed not only from the pre-existing commitments of those individuals and groups who engaged with bioethics, but also in response both to funding initiatives that followed technological developments, such as whole genome sequencing, and to ongoing research assessment initiatives which continue to emphasise the social and economic impact of university research.
New approaches are likely to emerge in response to more recent questions surrounding developments such as gene editing, 3-D printing, and biometric technologies, among other issues, but we should be wary of assuming what form they will take, or who will undertake them. By showing how the contours and influence of bioethics are connected to broader social, financial, and political concerns, history reminds us that its status and authority are likely to change in future. Arguably, the current climate appears less conducive for bioethics than at any period in its history.
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We would like to thank the three referees who submitted helpful comments on an early version of this article. Duncan Wilson's research on the history of bioethics was funded by a Wellcome Trust fellowship grant number and he is grateful for their support. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Oxford Academic. Google Scholar. Duncan Wilson. Cite Citation. Permissions Icon Permissions. Bioethics , History , Methods. Health and Society Wilson n 17 —22; Perkin n 23 — On criticism of IVF and embryo research in the early s, see Wilson n 17 — N Dower, Global Ethics, Approaches.