Showing papers by "Arthur L. Caplan published in 2001"

A national study of ethics committees.

Abstract: Conceived as a solution to clinical dilemmas, and now required by organizations for hospital accreditation, ethics committees have been subject only to small-scale studies. The wide use of ethics committees and the diverse roles they have played compel study. In 1999 the University of Pennsylvania Ethics Committee Research Group (ECRG) completed the first national survey of the presence, composition, and activities of U.S. healthcare ethics committees (HECs). Ethics committees are relatively young, on average seven years in operation. Eighty-six percent of ethics committees report that they played a role in ongoing clinical decision making through clinical ethics consultation. All are engaged in developing institutional clinical policy. Although 4.5% of HECs write policy on managed care, 50% of HEC chairs feel inadequately prepared to address managed care. The power and activity of ethics committees parallels the composition of those committees and the relationship of members to their institutions. The role of ethics committees across the nation in making policies about clinical care is greater than was known, and ethics committees will likely continue to play an important role in the debate and resolution of clinical cases and clinical policies.

NAS cloning hearing disappoints participants.

Abstract: The National Academy of Sciences (NAS) is arguably the most important scientific association in the United States. For decades it has been a key source of sound policy advice and solidly grounded opinion on matters pertaining to science, medicine, and engineering to the federal government. Early in August the NAS held a hearing on cloning. The report that will result from that hearing (due by the end of 2001) will no doubt receive keen attention from Congress. How did it happen that on a topic of crucial currency the NAS saw fit to welcome as equals into its ranks a group with so little scientific credibility? And why has the scientific community had so little to say about this puzzling collapse of standards with respect to who is asked to speak publicly on matters of science and medicine? The group in question is Brigitte Boisselier, Panayiotis Zavos, and Severino Antinori. Boisselier does not have a single Medline or Biosis publication. None of them has produced any Medline or Biosis indexed publications on cloning. None of the three has done any animal experimentation published in any Medline or Biosis indexed publications that would permit them to offer relevant information about the feasibility of cloning (for example, the embryological problems with the reprogramming of gene expression or attempts at animal cloning). When the leading organization of scientists and physicians in the United States invites unqualified persons to sit as equals meriting the same consideration due to those who actually have conducted responsible research on the topic at issue, and when, as happened at the hearing, those on the fringe are permitted to deprecate the work of those who actually have published research on cloning, then the distinctions between science, pseudoscience, and nonscience (if not nonsense) are eroded. No doubt the testimony of the real experts who were present during the hearing will lead, in the published report, to a resounding condemnation of the claims and assertions of Zavos, Boisselier, and Antinori. But the decision to treat these people as scientific equals in order to hear from them was wrong. Perhaps the greatest damage that can occur when the scientific community fails to clearly demarcate real science from nonscience is that bad public policy results. Already bills are moving through Congress, in state legislatures, and in international organizations to ban or prohibit all forms of cloning with human DNA, whether for reproduction or any other scientific purpose. Perhaps it is prudent to enact such bans, but there can be little doubt that the rush to enact them is being fueled by the perception that legitimate scientists and doctors are going to clone a human being in the near future. In a democracy, public policy must be based on more than the views of scientists, even on matters of medicine and science. But the voices of scientists must be heard by those responsible for making policy. What is happening in the discussion of cloning in American public policy, as the NAS panel made sadly evident, is that the scientific community has become too lax about making sure that the public and policy-makers can hear them clearly.

A National Study of Ethics

Abstract: ��� Conceived as a solution to clinical dilemmas, and now required by organizations for hospital accreditation, ethics committees have been subject only to small-scale studies. The wide use of ethics committees and the diverse roles they play compel study. In 1999 the University of Pennsylvania Ethics Committee Research Group (ECRG) completed the arst national survey of the presence, composition, and activities of U.S. healthcare ethics committees (HECs). Ethics committees are relatively young, on average seven years in operation. Eighty-six percent of ethics committees report that they play a role in ongoing clinical decision making through clinical ethics consultation. All are engaged in developing institutional clinical policy. Although 4.5% of HECs write policy on managed care, 50% of HEC chairs feel inadequately prepared to address managed care. The power and activity of ethics committees parallels the composition of those committees and the relationship of members to their institutions. The role of ethics committees across the nation in making policies about clinical care is greater than was known, and ethics committees will likely continue to play an important role in the debate and resolution of clinical cases and clinical policies. In many hospitals ethical dilemmas are addressed by a multidisciplinary hospital or healthcare ethics

Help Wanted: Entrepreneurs Needed to Serve Bioethics' Outsiders

Abstract: There are a myriad of daily biomedical encounters that are—for various reasons—ignored in the theater of bioethics. Oftentimes these encounters give rise to mundane ethical issues that are eclipsed by more dramatic cases where interpersonal conoict is sensationalized or technology only envisioned in science action suddenly becomes reality. Most often, dramatic stories of life and death push other cases to the fringes of the mainstream dialogue in bioethics. Many issues are sidelined because they are characteristically microethical—ethics problems that arise in the course of daily living for a particular population of people. They are less intellectually compelling to those who “do bioethics.” What Rosalie Kane and Arthur Caplan (1990) called “everyday ethics” is not all that prestigious or rewarding. Kuczewski (2001) claims that the survival of bioethics has depended on alignments with money and power. As a result, the problems of quotidian ethics have been set aside as a preoccupation—a hobby if you will—of bioethicists over the years. Added to this, bioethicists seem to continue to play by the rules of supply and demand. In domains where the ethics cases are commonplace, the demand for analysis of those cases is low. In areas where the issues are rare or freakish, the demand for bioethical attention is high. In essence, Kuczewski’s article begs the question: Should the rules of the current bioethics marketplace change? Another way to understand what Kuczewski is up to is to advance the role of “moral entrepreneur.” The sociologist Howard Becker (1963) created this notion in deaning those crusaders who take the initiative for a project or creation of rules that might right society (or in this case an intellectual community) from the toleration of a perceived wrong. Usually this occurs in the context of deviance, where a moral entrepreneur singles out an activity or individuals as being bad for society. A true moral entrepreneur identiaes outsiders as being morally somehow deacient and creates rules that will “be good for them.” Inversely, the outside group could be marginalized, and a moral entrepreneur might and it advantageous to create an alignment with that group—thus raising the status of both parties (Pfohl 1977). Becker’s idea seems to inform the claims Kuczewski makes, since he is pointing out problems in the structure of bioethics and deaciencies in the ways in which bioethicists presently work. Kuczewski’s crafting of new rules for the bioethics community to play by is a red oag signaling there is entrepreneurial activity afoot. Since, as he claims, bioethics has deviated from its proper trajectory as “the ethics of life,” Kuczewski constructs ave convictions that will redirect bioethics to include the disabled. Adding detail, he suggests time allotments that ought to be donated by bioethicists to sustain “disability ethics.” Kuczewski makes policy suggestions; he makes suggestions on metaphysical understandings (i.e., how we idealize “abled” life); and he points to new directions in bioethics research. All of these initiatives will, he hopes, activate the exchange of ideas between bioethics and the disabled community, forming a symbiotic relationship. A win-win is every entrepreneur’s goal. But the symbioses between bioethics and speciac groups come at a cost: further fragmentation of the aeld. It may seem at arst glance that urging bioethics to reach out to as many groups and communities as possible is a good thing. But by creating a new set of rules for bioethicists, which target in this case only the disabled community, Kuczewski is actually threatening what bioethics ought to do. To be effective, bioethics cannot be the bioethics of the