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Anger and Forgiveness"Are You There Alone?"10 Good Questions about Life and DeathA Casebook of Ethical Challenges in NeuropsychologyA Companion to BioethicsA Companion to BioethicsA Companion to GenethicsA Companion to GenethicsA Companion to Muslim EthicsA Cooperative SpeciesA Critique of the Moral Defense of VegetarianismA Delicate BalanceA Fragile LifeA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Natural History of Human MoralityA Philosophical DiseaseA Practical Guide to Clinical Ethics ConsultingA Question of TrustA Sentimentalist Theory of the MindA Short Stay in SwitzerlandA Tapestry of ValuesA Very Bad WizardA World Without ValuesAction and ResponsibilityAction Theory, Rationality and CompulsionActs of ConscienceAddiction and ResponsibilityAddiction NeuroethicsAdvance Directives in Mental HealthAfter HarmAftermathAgainst AutonomyAgainst BioethicsAgainst HealthAgainst Moral ResponsibilityAgency and AnswerabilityAgency and ResponsibilityAgency, 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LifeDelusions of GenderDementiaDemocracy in What State?Demons of the Modern WorldDescriptions and PrescriptionsDesert and VirtueDesire, Practical Reason, and the GoodDestructive Trends in Mental HealthDeveloping the VirtuesDid My Neurons Make Me Do It?Difference and IdentityDigital HemlockDigital SoulDignityDisability BioethicsDisability, Difference, DiscriminationDisordered Personalities and CrimeDisorders of VolitionDisorientation and Moral LifeDivided Minds and Successive SelvesDoes Feminism Discriminate against Men?Does Torture Work?Double Standards in Medical Research in Developing CountriesDrugs and JusticeDworkin and His CriticsDying in the Twenty-First CenturyEarly WarningEconomics and Youth ViolenceEmbodied RhetoricsEmerging Conceptual, Ethical and Policy Issues in BionanotechnologyEmotional ReasonEmotions in the Moral LifeEmotions in the Moral LifeEmpathyEmpathy and Moral DevelopmentEmpathy and MoralityEmpirical Ethics in PsychiatryEncountering NatureEncountering the Sacred in PsychotherapyEngendering International HealthEnhancing EvolutionEnhancing Human CapacitiesEnoughEros and the GoodErotic InnocenceErotic MoralityEssays on Derek Parfit's On What MattersEssays on Free Will and Moral ResponsibilityEthical Choices in Contemporary MedicineEthical Conflicts in PsychologyEthical Dilemmas in PediatricsEthical Issues in Behavioral ResearchEthical Issues in Dementia CareEthical Issues in Forensic Mental Health ResearchEthical Issues in the New GeneticsEthical LifeEthical Reasoning for Mental Health ProfessionalsEthical TheoryEthical WillsEthically Challenged ProfessionsEthicsEthicsEthicsEthics and AnimalsEthics and ScienceEthics and the A PrioriEthics and the Discovery of the UnconsciousEthics and the Metaphysics of MedicineEthics at the CinemaEthics Case Book of the American Psychoanalytic AssociationEthics Done RightEthics ExpertiseEthics for EveryoneEthics for PsychologistsEthics for the New MillenniumEthics in CyberspaceEthics in Health CareEthics In Health Services ManagementEthics in Mental Health ResearchEthics in PracticeEthics in PsychiatryEthics in PsychologyEthics in Psychotherapy and CounselingEthics of PsychiatryEthics without OntologyEthics, Culture, and PsychiatryEthics, Sexual Orientation, and Choices about ChildrenEvaluating the Science and Ethics of Research on HumansEvilEvil GenesEvil in Modern ThoughtEvil in Modern ThoughtEvolution, Gender, and RapeEvolutionary Ethics and Contemporary BiologyEvolutionary Psychology and ViolenceEvolved MoralityExperiments in EthicsExploding the Gene MythExploiting ChildhoodFacing Human SufferingFact and ValueFaking ItFalse-Memory Creation in Children and AdultsFat ShameFatal FreedomFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminist Ethics and Social and Political PhilosophyFeminist TheoryFinal ExamFirst Do No HarmFirst, Do No HarmFlashpointFlesh WoundsForced to CareForgivenessForgivenessForgiveness and LoveForgiveness and ReconciliationForgiveness and RetributionFoucault and the Government of DisabilityFoundational Issues in Human Brain MappingFoundations of Forensic Mental Health AssessmentFree WillFree Will And Moral ResponsibilityFree Will and Reactive AttitudesFree Will, Agency, and Meaning in LifeFree?Freedom and ValueFreedom vs. InterventionFriendshipFrom Darwin to HitlerFrom Disgust to HumanityFrom Enlightenment to ReceptivityFrom Morality to Mental HealthFrom Silence to VoiceFrom Valuing to ValueFrontiers of JusticeGender in the MirrorGenetic PoliticsGenetic ProspectsGenetic ProspectsGenetics of Original SinGenetics of Original SinGenocide's AftermathGetting RealGluttonyGood WorkGoodness & AdviceGreedGroups in ConflictGrowing Up GirlGut FeminismHabilitation, Health, and AgencyHandbook for Health Care Ethics CommitteesHandbook of BioethicsHandbook of Children's RightsHandbook of PsychopathyHappinessHappiness and the Good LifeHappiness Is OverratedHard FeelingsHard LuckHardwired BehaviorHarmful ThoughtsHeal & ForgiveHealing 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War and LawOn ApologyOn Being AuthenticOn EvilOn Human RightsOn The Stigma Of Mental IllnessOn the TakeOn Virtue EthicsOn What MattersOn What We Owe to Each OtherOne ChildOne Nation Under TherapyOne World NowOne World NowOur Bodies, Whose Property?Our Bodies, Whose Property?Our Daily MedsOur Faithfulness to the PastOur Posthuman FutureOut of EdenOut of Its MindOut of the ShadowsOverdosed AmericaOxford Handbook of Psychiatric EthicsOxford Textbook of Philosophy of PsychiatryPassionate DeliberationPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonalities on the PlatePersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, Pro-ChoiceProcreation and ParenthoodProfits Before People?Progress in BioethicsProperty in the BodyProzac As a Way of LifeProzac on the CouchPsychiatric Aspects of Justification, Excuse and Mitigation in Anglo-American Criminal Law Psychiatric EthicsPsychiatry and EmpirePsychological Concepts and Biological PsychiatryPsychology and Consumer CulturePsychology and LawPsychotropic Drug Prescriber's Survival GuidePublic Health LawPublic Health Law and EthicsPublic PhilosophyPunishing the Mentally IllPunishmentPursuits of WisdomPutting Morality Back Into PoliticsPutting on VirtueQuality of Life and Human DifferenceRaceRadical HopeRadical VirtuesRape Is RapeRe-creating MedicineRe-Engineering Philosophy for Limited BeingsReason's GriefReasonably ViciousReckoning With HomelessnessReconceiving Medical EthicsRecovery from SchizophreniaRedefining RapeRedesigning HumansReducing the Stigma of Mental IllnessReflections On How We LiveReframing Disease ContextuallyRefusing CareRefuting Peter Singer's Ethical TheoryRelative JusticeRelativism and Human RightsReligion ExplainedReprogeneticsRescuing JeffreyResponsibilityResponsibility and PsychopathyResponsibility and PunishmentResponsibility and PunishmentResponsibility from the MarginsResponsible GeneticsRethinking CommodificationRethinking Informed Consent in BioethicsRethinking Mental Health and DisorderRethinking RapeReturn to ReasonRevolution in PsychologyRightsRights, Democracy, and Fulfillment in the Era of Identity PoliticsRisk and Luck in Medical EthicsRobert NozickRousseau and the Dilemmas of Modernity Rule of Law, Misrule of MenRun, Spot, RunRunning on RitalinSatisficing and MaximizingSchizophrenia, Culture, and SubjectivityScience and EthicsScience in the Private InterestScience, Policy, and the Value-Free IdealScience, Seeds and CyborgsScratching the Surface of BioethicsSecular Philosophy and the Religious TemperamentSeeing the LightSelf-ConstitutionSelf-Made MadnessSelf-Trust and Reproductive AutonomySentimental RulesSex Fiends, Perverts, and PedophilesSex OffendersSex, Family, and the Culture WarsSexual DevianceSexual EthicsSexual PredatorsSexualized BrainsShaping Our SelvesShock TherapyShould I Medicate My Child?ShunnedSick to Death and Not Going to Take It AnymoreSickoSide EffectsSidewalk StoriesSister CitizenSkeptical FeminismSocial Inclusion of People with Mental IllnessSocial JusticeSociological Perspectives on the New GeneticsSome We Love, Some We Hate, Some We EatSovereign VirtueSpeech MattersSpiral of EntrapmentSplit DecisionsSticks and StonesStories MatterSubjectivity and Being SomebodySuffering, Death, and IdentitySuicide ProhibitionSurgery JunkiesSurgically Shaping ChildrenTaking Morality SeriouslyTaming the Troublesome ChildTechnology and the Good Life?TestimonyText and Materials on International Human RightsThe Aims of Higher EducationThe Almost MoonThe Altruistic BrainThe American Psychiatric Publishing Textbook of Forensic PsychiatryThe Animal ManifestoThe Animals' AgendaThe Art of LivingThe Autonomy of MoralityThe Beloved SelfThe Best Things in LifeThe Big FixThe Bioethics ReaderThe Biology and Psychology of Moral AgencyThe Blackwell Guide to Medical EthicsThe Body SilentThe BondThe Book of LifeThe Burden of SympathyThe Cambridge Companion to Virtue EthicsThe Cambridge Companion to Virtue EthicsThe Cambridge Textbook of BioethicsThe Case against Assisted SuicideThe Case Against PerfectionThe Case Against PunishmentThe Case for PerfectionThe Case of Terri SchiavoThe Challenge of Human RightsThe Code for Global EthicsThe Colonization Of Psychic SpaceThe Commercialization of Intimate LifeThe Common ThreadThe Connected SelfThe Constitution of AgencyThe Creation of 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ScienceUnderstanding AbortionUnderstanding CloningUnderstanding EmotionsUnderstanding EvilUnderstanding Kant's EthicsUnderstanding Moral ObligationUnderstanding Physician-Pharmaceutical Industry InteractionsUnderstanding TerrorismUnderstanding the GenomeUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnhingedUnprincipled VirtueUnsanctifying Human Life: Essays on EthicsUnspeakable Acts, Ordinary PeopleUp in FlamesUpheavals of ThoughtUsers and Abusers of PsychiatryValue-Free Science?Values and Psychiatric DiagnosisValues in ConflictVegetarianismViolence and Mental DisorderVirtue EthicsVirtue, Rules, and JusticeVirtue, Vice, and PersonalityVirtues and Their VicesVulnerability, Autonomy, and Applied EthicsWar Against the WeakWar, Torture and TerrorismWarrior's DishonourWeaknessWelfare and Rational CareWhat Genes Can't DoWhat Have We DoneWhat Is a Human?What Is Good and WhyWhat Is Good and WhyWhat Is the Good Life?What Price Better Health?What Should I 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How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
In chapter ten of this collection van Heijst suggests that in order to "to naturalize bioethics, one must adopt the perspective of the ethics of care." [p.199] The influence that feminist ethics of care has had on bioethics (pre, post and productive of the empirical turn) cannot be underestimated and no bioethicist at work today can afford not to be cognizant of its critiques, insights and approach. Many of the other essays presented here bear out van Heijst's claim yet this collection, and a naturalized approach to bioethics and ethics more generally, is more than an expansion or continuation of an ethics of care approach or the feminist project. However, whilst there are excursions into narrative and sociological approaches to ethics in this collection it broadly remains within the (bio)ethics of care and cognizant emotionally sophisticated ethical perspectives. In doing so the essays as a whole present something of a synthesis of the state of the art of the feminist/ care approach to naturalized bioethics and, as such, it deserves to be read by widely by academic and professional (in the American mode) bioethicists. Its appeal beyond the borders of bioethics is somewhat limited by this self same 'state of the art' nature. Nevertheless those interested in the substantive focus of particular individual essays would certainly benefit from the insights on offer.
Unfortunately the focus of particular essays is not always indicated by their titles. For example Jackie Leach Scully's 'Moral Bodies: Epistemologies of Embodiment' presents a discussion of deafness/ hearing impaired individuals and communities, the creation of cultural values and the resulting difference in bioethical perspectives. Through her discussion of a congenital hearing impaired couple who were seeking to have, or increase their chances of having, a hearing impaired child she presents an analysis from the perspective of what might be taken to be standpoint epistemology. However through the presentation of a brief overview of deaf history and culture in conjunction with Bourdieu's concept of the habitus this is developed into a stronger argument regarding the validity and nature of background assumptions, particularly the degree to which they are embodied and therefore entrenched. The insight generated by analysis driven by Bourdieu's habitus and its operations is with classic Bourdieuan reflexivity then applied to bioethics and bioethicists. The result in an undermining of bioethical certainties and an attempt to foster greater dialogue between those, as Bourdieu would say, who occupy differing (moral and disciplinary) positions within the field.
In 'Holding on to Edmund' Lindemann considers the way in which our intimate and not so intimate others are responsible for reflecting, upholding and constructing our self-identity. The value placed on autonomy in bioethics has resulted in the proliferation of advanced directives and living wills. This has impacted on families and significant others casting them in a role of upholding an incapacitated patient's wishes. As Lindemann has it they are holding onto or promoting the patients identity in circumstances where they are unable to do it themselves. However patients families find themselves in a relatively weak position from which to assert patient's wishes when such wishes are at odds with those of a techno-logical health care system. Medicine adopts a relatively narrow perspective on autonomy which logically results in a disregard for the relevance of 'personal identity' and prior-to-the-fact decision making. Standard bioethical perspectives and medical practices rely on a singular 'hard' notion of autonomy which has, to a degree, historically acted to empower patients (or perhaps bioethicists). In cases and analyses such as this it now appears to operate to re-empower the physician (and the bioethicist) and not the patient. Indeed the disregard for autonomy as a thick aspect of identity (or personal identity as suggestive of a thick conception of autonomy) places patients who are non-incapacitated and competent but who are very ill and possibly dying in relatively powerless position from which decisions have to be made i.e. in their hospital sick bed. Lindemann notes that there is no 'ideal' or neutral position from which any decision can be made and that the possibility that a patient might legitimately change their mind must be retained. Nevertheless Lindermann concludes that a proxy's role is to 'hold a patient in their identity' a necessarily interpersonal and relational activity.
This is at odds with the widely held view of medical professionals, in the UK at least, that the proxy must be able to unproblematically report what the patient themselves would have wanted. As Lindemann's notion of identity and autonomy is interpersonal and relational they are considered not to be simple properties of the self but complex socially produced phenomenon. A mutual construction and co-constitution of personal identity is being suggested. The challenge for medical professionals is how to see past the 'objective' perspective which is naturally predisposed towards the value of continued technological medical interventions and the exercise of medical professional autonomy; how might they move towards a more humanistic perspective defined by interpersonal understanding and the mutual construction of the way forward?
Chamber's essay offers another foray into his narrative perspective on bioethics in theory and practice. His successful use of literary perspectives on bioethical activity is here first turned towards a consideration of two synopses of the recent film The Eternal Sunshine of a Spotless Mind. These two synopses interpret and reconstruct the film in quite different ways. Considering a number of perspectives on narrative and ethics, most prominently Alasdair MacIntyre's, he promotes his view of bioethicists and healthcare professionals as engaged in, and therefore a part of, a process of storytelling. Chamber's is suggesting we must acknowledge that bioethicists often become part of the story itself: through their 'professional activities' (although the hospital based bioethicist consultant is a predominantly American phenomena); through becoming a part of the 'political' narrative as seen in big news cases such as Terry Schiavo; or through simply adopting the location of narrator as we do when we relate cases for analysis. The narratives of bioethics (and for that matter of medical science) have a tendency towards giving an impression of objectivity, of unproblematically representing the truth, or at least of assuming there is out there in the world some 'master narrative' which can, through some rigorously applied methodology, be accessed or determined. Chamber's fictional bioethics presents a view which refuses to reify the knowledges of bioethicists and places them, and us, firmly in the social realm.
The slight ambiguity in the subtitle of this collection reveals the aim of a critical, naturalized and empirically orientated bioethics. The aim is not only to be a responsible bioethics but also a respond-able and responsive bioethics which meets the needs of those on, for and, most importantly, with it commentates and engages; whether they are professionals or patients, interested or disinterested, empowered or disempowered (marginalized). As a collection largely orientated towards an understanding of bioethics in the American context the epilogue is concerned with recommendations for hospital based practice although it also concerns the role of bioethicists as educators which is perhaps more widely pertinent. The view of bioethics they promote is one of a mutual striving to understand the moral landscapes of medicine and modern health care practices and seeks to encourage and engage with the socially specific and culturally complex embodied in each bioethical case we encounter.
© 2009 Nathan Emmerich
Nathan Emmerich, School Of Sociology, Social Policy and Social Work, Queens University Belfast, is completing a PhD which concerns the teaching and learning of medical ethics on the UK undergraduate medical degree.
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