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Twenty-first-century poets, particularly queer Indigenous and queer of color poets, have taken particular interest in lyric, its excesses, and its transformative potential. Queer Indigenous and queer of color poets make clear that the relationships that make and sustain life are not merely those between human selves. The poems discussed retain the physicality associated with the lyric voice but reject its fantasy of a self-organizing, independent consciousness. They explore what might happen when the speaker's crystalline singularity is shattered – first, by a more accurate conception of the interdependence of living beings; and second, by historical and contemporary conditions of mass death. Tommy Pico’s Nature Poem makes astute use of the conventions of lyric poetry and its associated reading practices in order to invoke, if not inaugurate something different – poetry that disidentifies with the form of the person and that radically expands the tripartite relation of speaker, addressee, and audience that structures the American lyric tradition.
The conclusion sums up the work, indicating the core elements shared by (Hellenic) theories of daimonification along with (Jewish and Christian) theories of angelification. One common element is the link of virtue (ethical transformation) with physical and cognitive transformation. It is this persistent link that allows ancient theories of posthuman transformation to serve as correctives for current Transhumanist visions of posthuman enhancement. Transhumanists often speak of cognitive and physical improvements with no robust reflection on ethical or moral improvement. Posthuman enhancement must never be defined apart from morality, but in terms of it. Morality cannot simply be programmed from without, nor can it be governed by the overall value of personal autonomy.
This introductory chapter introduces, first, the concept of bioethical expertise. It discusses the context of its emergence, its specificities as well as its special authority in policymaking.
Second, it presents the book’s argument, detailing both how the mobilisation of bioethical expertise plays out in the governance of scientific and technological innovation, and the way such expertise is produced, at the junction of the expert and the political spheres.
Third, the chapter introduces the conceptual framework of the book, making the case in particular that different logics of iteration characterise the relationship between experts, policymakers and other governance actors, acting as stabilisation mechanisms between knowledge and politics. Finally, the implications of the book are discussed, in relation to broader debates on the nature of expertise, its role in policy and the relationship between knowledge and politics.
Littoz-Monnet provides a fresh analysis of the enmeshment of expert knowledge with politics in global governance, through a unique investigation of bioethical expertise, an intriguing form of 'expert knowledge' which claims authority in the ethical analysis of issues that arise in relation to biomedicine, the life sciences and new fields of technological innovation. She makes the case that the mobilisation of ethics experts does not always arise from a motivation to rationalise governance. Instead, mobilising ethics experts - who are endowed with a unique double-edged authority, both 'democratic' and 'epistemic' - can help policy-makers manoeuvre policy conflicts on scientific and technological innovations and make their pro-science and innovation agendas possible. Bioethical expertise is indeed shaped in a political and iterative space between experts and those who do policy. The book reveals the mechanisms through which certain global governance narratives, as well as the types of expertise they rely on, remain stable even when they are contested.
The neurodiversity movement argues that certain diagnoses implicating the brain, most notably autism, do not reflect neurological disorders but rather neurological diversity. Neurodiversity movements lie at the intersection of culture, mind, and brain as mind/brain discourses are taken up as cultural practice used in individual and collective identity formation as well as social and political action. Neurodiversity perspectives intersect with important considerations in bioethics, particularly around questions of respect and justice for autistic people. This chapter describes neurodiversity and related concepts, discusses the way neurodiversity can inform bioethics as a conceptual lens, and summarizes cross-cultural research on neurodiversity movements that can help address neurodiversity-informed bioethics questions. It concludes with proposed directions for future research.
The role of bioethicists amidst crises like the COVID-19 pandemic is not well defined. As professionals in the field, they should respond, but how? The observation of the early days of pandemic confinement in Finland showed that moral philosophers with limited experience in bioethics tended to apply their favorite theories to public decisions with varying results. Medical ethicists were more likely to lend support to the public authorities by soothing or descriptive accounts of the solutions assumed. These are approaches that Tuija Takala has called the firefighting and window dressing models of bioethics. Human rights lawyers drew attention to the flaws of the government’s regulative thinking. Critical bioethicists offered analyses of the arguments presented and the moral and political theories that could be used as the basis of good and acceptable decisions.
Current medical ethics and bioethics, as well as neurosurgical ethics in particular, are derived from a number of historical sources. Early medical ethics became increasingly deontological, and transformed into bioethics with increasing societal impact with scientific interventions. Neurosurgeons have been involved in ethical issues since the inception of the field.
Recent advances in machine learning (ML) promise far-reaching improvements across medical care, not least within psychiatry. While to date no psychiatric application of ML constitutes standard clinical practice, it seems crucial to get ahead of these developments and address their ethical challenges early on. Following a short general introduction concerning ML in psychiatry, we do so by focusing on schizophrenia as a paradigmatic case. Based on recent research employing ML to further the diagnosis, treatment, and prediction of schizophrenia, we discuss three hypothetical case studies of ML applications with view to their ethical dimensions. Throughout this discussion, we follow the principlist framework by Tom Beauchamp and James Childress to analyse potential problems in detail. In particular, we structure our analysis around their principles of beneficence, non-maleficence, respect for autonomy, and justice. We conclude with a call for cautious optimism concerning the implementation of ML in psychiatry if close attention is paid to the particular intricacies of psychiatric disorders and its success evaluated based on tangible clinical benefit for patients.
Governmental reactions to crises like the COVID-19 pandemic can be seen as ethics communication. Governments can contain the disease and thereby mitigate the detrimental public health impact; allow the virus to spread to reach herd immunity; test, track, isolate, and treat; and suppress the disease regionally. An observation of Sweden and Finland showed a difference in feasible ways to communicate the chosen policy to the citizenry. Sweden assumed the herd immunity strategy and backed it up with health utilitarian arguments. This was easy to communicate to the Swedish people, who appreciated the voluntary restrictions approach and trusted their decision makers. Finland chose the contain and mitigate strategy and was towards the end of the observation period apparently hesitating between suppression and the test, track, isolate, and treat approach. Both are difficult to communicate to the general public accurately, truthfully, and acceptably. Apart from health utilitarian argumentation, something like the republican political philosophy or selective truth telling are needed. The application of republicanism to the issue, however, is problematic, and hiding the truth seems to go against the basic tenets of liberal democracy.
The role of bioethicists amidst crises like the COVID-19 pandemic is not well defined. As professionals in the field, they should respond, but how? The observation of the early days of pandemic confinement in Finland showed that moral philosophers with limited experience in bioethics tended to apply their favorite theories to public decisions, with varying results. Medical ethicists were more likely to lend support to the public authorities by soothing or descriptive accounts of the solutions assumed. These are approaches that Tuija Takala has called the firefighting and window dressing models of bioethics. Human rights lawyers drew attention to the flaws of the government’s regulative thinking. Critical bioethicists offered analyses of the arguments presented and the moral and political theories that could be used as the basis of good and acceptable decisions.
There are extrinsic as well as intrinsic limits to the resources available for health care. Therefore, economic factors have become an essential part of medical activity, leading to a disruption of the traditional doctor-patient relationships. A new economic approach of health care (ie, through managed care) and ethical attitude (to overcome the limits of managed care) are essential, especially in psychiatric practice.
Is it ethical when doctors breach their pregnant patients’ confidentiality? Is it legal? What about HIPAA (properly known as the Health Insurance Portability and Accountability Act of 1996)? Are there different rules for pregnant women than for men? These are some of the questions women ask me after I give a talk. I understand this bewilderment and, for many, fear. At the heart of their questions resides this chilling thought: Could this happen to me or my daughter? Depending on where they live, the answer may be yes. And, increasingly, wealth will not save them. As this Chapter explains, physicians owe their patients care, confidentiality, loyalty, and trust, and the principle that undergirds all of this – the fiduciary relationship – is not contingent on the sex of the patient. However, with increased pressure from state legislatures and prosecutors, some doctors and nurses have abrogated their responsibilities to their patients. Among them, some are genuinely fearful that unless they adhere to whatever law enforcement demands of them, they may lose their licenses to practice medicine. Some of these doctors are genuinely ambivalent about their duties. These doctors tell me they feel powerless.
Israel defines itself as a ‘Jewish democratic state’, an expression that conveys the Jewish and liberal roots of its political, cultural and legal identity. In Jewish tradition, attempting to cure disease and save lives is of paramount value and Jewish culture hence encourages open-minded attitudes towards research efforts that have therapeutic goals. Zionist narratives also play a role in shaping policy towards genetic and reproductive technologies and pro-science attitudes echo the Zionist narrative that links scientific and technological innovation with the notion of transforming the Jews into a modern nation. Consequently, Israel does not ban basic research involving human germline modification and draws the line only at attempting to create a ‘genetically modified person’. Human germline genome modification is regulated in Israel under the 1999 Prohibition of Genetic Intervention (Human Cloning and Genetic Manipulation of Reproductive Cells) Law. This Law has been amended three times: in 2004, 2009 and 2016. The current version is set to expire on 23 May 2020. The Israeli Law prohibits two activities: human reproductive cloning, and the use of ‘reproductive cells that have undergone a permanent intentional genetic modification (germline gene therapy) in order to cause the creation of a person’.
In France, civil law provisions on research involving human subjects, on donation and use of human body parts, and on medically assisted reproduction – originally developed between 1988 and 1994 and generally referred to as loi de bioéthique (law on bioethics) – specify whether and under which statutory conditions activities potentially leading to human germline genome modification can be undertaken. International law, including European law, poses further conditions. This chapter explores legislative and regulatory constraints on this type of research in France, analyzing how they developed over time to reach their present state. We will show that, in France, it is prohibited to create a human embryo solely for research purposes; that, however, research activities on supernumerary embryos and human embryonic stem cells are possible upon authorization by the national agency on biomedicine; but that, nevertheless, alterations to the genome of an embryo under circumstances that allow the modifications to pass on to future generations (i.e. through a successful pregnancy) are strictly prohibited. A peculiar feature of French legislation in this domain is that the law on bioethics is regularly updated in light of new technological or scientific developments, and as a result of a national public consultation held at least every five years. In 2018 one such rounds of public consultation took place, and a report summarizing its outcome is now being considered as the basis for possible legislative reform – including in the domain of genetic engineering. While it is not possible to anticipate future legislative developments, the report signals some degree of openness in the French civil society regarding the use of genetic engineering and genome editing, at least in the context of research.
The use of genetic technologies for reproductive, farming, agricultural and scientific purposes has long been a matter of public concern in Switzerland. As a result of a series of legislative initiatives at the federal level, as well as of popular referenda, the country developed one of the most restrictive regulatory environments in Europe for research, potentially leading to human germline genome modification. In particular, any genetic manipulation of reproductive cells or embryos is strictly forbidden, regardless its intended purpose. This chapter will illustrate the way constitutional- and federal-level legislation, as well as international law and regulatory provisions rigidly constrain research activities that could potentially lead to genetic alterations in humans and their progeny. In such a restrictive context, it is highly unlikely that recent technical advances in genetic engineering and genome editing will be employed to produce germline genome modifications for either medical or purely scientific purposes. Furthermore, while the Swiss National Advisory Commission for Biomedical Ethics has recently expressed partial support for basic research possibly involving the genetic modification of human embryos, there are currently no indications that legislative initiatives will be undertaken to ease current regulations on such controversial matters.
This book has considered ethics in the context of human vulnerability. We are vulnerable because we can be affected by things across the life span, and we can be affected by things because we are physical beings – part of the world around us and subject to the passage of time. Consequently, a life can come to an end at any time. For this reason, death is not only completely normal, but inevitable. Nevertheless, death is typically regarded as something regrettable. Issues of personhood and autonomy lie at the centre of bioethical debates about the ending of human life, especially where this involves abortion and euthanasia. Against the backdrop of these issues, this chapter provides an overview of the main legal and ethical considerations relating to abortion and euthanasia.