Journal of Bioethical Inquiry, Volume 5, Number 1 (March 2008)

Editorials

Editorial

Ian Kerridge and Paul A. Komesaroff

The Epistemology and Ethics of Journal Reviewing: A Second Look

Paul A. Komesaroff, Ian Kerridge, and Wendy Lipworth

Recent Developments

Recent Developments

Cameron Stewart

Original Research

Environmental Change, Injustice and Sustainability

Colin D. Butler
This paper argues that a combination of increasing inequality, hypocrisy, population growth and adverse global environmental change imperils our civilisation. Selected examples of existing inequality and the immoral treatment of human beings are provided from countries of the Asia Pacific. There is also limited discussion of the global eco-social crisis, stressing the links between environmental scarcity and the human responses of resentment, conflict, terrorism and ill-governance. The essay contends that just as the lives of unborn humans similar to us are of interest and value to bio-ethicists, so too should be the lives and descendants of people who are unlike us, even if such people are perceived to be substantially different to ourselves in terms of status, culture and spending power. It is argued that it is in the interests of ourselves, society, and global civilisation that the lives of such people are considered and where possible improved in order to foster the “sustainability transition” needed to secure our collective future. The essay concludes with a discussion of an important element for securing our future: the development and implementation of alternative economic systems which will provide more accurate indicators of global progress.

Western Notions of Informed Consent and Indigenous Cultures: Australian Findings at the Interface

Pam McGrath and Emma Phillips
Despite the extensive consideration the notion of informed consent has heralded in recent decades, the unique considerations pertaining to the giving of informed consent by and on behalf of Indigenous Australians have not been comprehensively explored; to the contrary, these issues have been scarcely considered in the literature to date. This deficit is concerning, given that a fundamental premise of the doctrine of informed consent is that of individual autonomy, which, while privileged as a core value of non-Indigenous Australian culture, is displaced in Indigenous cultures by the honouring of the family unit and community group, rather than the individual, as being at the core of important decision-making processes relating to the person. To address the hiatus in the bioethical literature on issues relating to informed consent for Aboriginal peoples, the following article provides findings from a two-year research project, funded by Australia’s National Health and Medical Research Council (NHMRC), conducted in the Northern Territory. The findings, situated in the context of the literature on cultural safety, highlight the difference between the Aboriginal and biomedical perspectives on informed consent.

Privacy and Property Issues for a Familial Cancer Service

Graeme Suthers
Approximately 1 in 30 people develop cancer due to an underlying familial predisposition. Genetic counselling and testing for people with (and at risk of) familial cancer are becoming more widely available, but service providers need to address challenging issues in relation to privacy and property. As in any counselling situation, a genetic counsellor seeks to ensure that the principles of autonomy, confidentiality, beneficence, and equity operate in favour of the client. But in dealing with a familial disorder, the application of these principles to the individual must be balanced with the potential for these principles to apply to other family members. This paper summarises the recent experience of a familial cancer service in seeking to avoid situations in which these principles, operating for both individual clients and their relatives, can come into conflict.

Introduction to J.R. Martin’s “Negotiating Values: Narrative and Exposition”

Christopher F. C. Jordens

Negotiating Values: Narrative and Exposition

J. R. Martin
In this paper I focus on the limits of narrative by asking what kinds of things narratives do, and what kinds of texts do related things in other ways. In particular I focus on how narrative genres organise time in relation to value, drawing on functional linguistic models of temporality and evaluation. From a linguistic perspective, the various narrative genres negotiate different kinds of solidarity with listeners, and so the limits of narrative materialise various possibilities for communing in a culture, alongside the potentialities for construing community through related and other genres of discourse—since in general, the limits/possibilities of our language (and attendant modalities of communication) are the limits/possibilities of our social world.

Enriching Our Views on Clinical Ethics: Results of a Qualitative Study of the Moral Psychology of Healthcare Ethics Committee Members

Eric Racine
The contribution of healthcare ethics committee (HEC) members to HECs is fundamental. However, little is known about how HEC members view clinical ethics. We report results from a qualitative study of the moral psychology of HEC members. We found that contrary to the existing Kohlberg-based studies, HEC members hold a pragmatic non-expert view of clinical ethics based mainly on respect for persons and a commitment to the patient’s good. In general, HEC members hold deflationary views regarding moral theory. Ethical principles are not abstract foundations but the expression of moral commitments to patients that pre-exist awareness of moral theory. Emotions and proximity to patient sufferance fundamentally shape the views of HEC members on clinical ethics. Further work at the intersection of clinical ethics and qualitative research could bring to the foreground lay perspectives on moral problems that may differ from bioethics expert views.

Just When You Thought the Euthanasia Debate Had Died

Alan Rothschild
The death by assisted suicide in Switzerland of Australian Dr. John Elliott, in early 2007 has highlighted the inadequacy of the law pertaining to medical decisions at end-of-life, both from a legal as well as ethical perspective. Despite being illegal in most jurisdictions around the world, physician-assisted death is a reality, in part because of the flexibility, inconsistent application and, at times, invisibility, of laws surrounding it. The appropriate response to this should be greater transparency by a reform of the law.

Case Studies

Republication: Public Health Dilemmas Concerning a Two-year-old Hepatitis B Carrier

Els Reijn and Marcel Verweij
This article was originally published in the Journal of Bioethical Inquiry 4(3): 245–246, http://dx.doi.org/10.1007/s11673-007-9071-4. It is reprinted here for the sake of coherence.

Response

Jason P. Lott

Response

R. Batey

Response

Gwendolyn L. Gilbert

Response

Marcel Verweij and Jim van Steenbergen

In That Case: Disability: Whose Perspective, What Problem?

Christopher Newell

Notices

Journal of Bioethical Inquiry: Reviewing Policy

Ian Kerridge