4 essays look at the next generation of bioethics

November 11, 2010

To celebrate 40 years of pioneering bioethics publication, the Hastings Center Report, the world's first bioethics journal, looked to the future, asking young scholars to write about what the next generation of bioethicists should take up. Out of 195 compelling submissions, four of the best essays were selected for publication in the November-December issue.

Three of the essays envision forging into new areas, such as the ethical obligations of pharmaceutical industry, questions around the emerging field of , and public health. Another proposes broadening the approach to dying, a foundational issue of bioethics. An undergraduate, a graduate student, an early career professor who is also a practicing physician, and a Belgian researcher are the authors.

A second set of essays, focusing on bioethics methodology, will be published in 2011.

"Picking the essays we wanted to publish turned out to be surprisingly difficult," said Gregory E. Kaebnick, editor of the Report. "We not only wanted good essays; we also wanted to represent the range of topics that people had written about and the range of people writing them up. But it's a good problem to have, of course, and it gives us great confidence about the future of bioethics."

"Establishing a 'Duty of Care' for Pharmaceutical Companies" calls upon bioethics to focus on the ethical responsibilities that drug companies have to the people they supply. Just as doctors, nurses, and other clinicians have a duty to give competent care to patients, drug companies should "place the good of the populace over the good of the stockholders," writes Remy Miller, a junior at Transylvania University who plans to pursue degrees in medicine and bioethics. She suggests that companies start by adhering to the bioethics principles of justice, beneficence, and autonomy.

"A Role for Moral Vision in Public Health" recommends that bioethics join forces with public health to develop a moral vision to inform policy and practice. While public health interventions were once accomplished through improvements in infrastructure, such as better sanitation, "today's public health goals often require changing individual behavior, often through state action," writes Daniel B. Rubin, a doctoral student in and a law student at the University of Michigan Rubin. "Such interventions raise substantive questions about the extent to which government . . . should intrude on individual bodies to improve the health of the body politic."

"The Art of Dying Well" argues that one of the most pressing bioethical concerns is to create a framework for teaching an aging population to prepare for death and support one another through the dying process. Even though bioethics has always debated end-of-life issues, Lydia Dugdale, MD, an assistant professor at Yale School of Medicine, says, "American society remains ill equipped for the experience of dying." Among the reasons are advances in medical technology that have "obscured the distinction between death and life," physicians' difficulty in discussing end-of-life issues with their patients, and the secularization of Western culture, which has marginalized the role of religion in preparing people for death. Bioethics can help, Dugdale says, by working to create "a modern version of the Ars moriendi, or Art of Dying, which expressed the societal and ecclesiastical response in the Middle Ages to the widespread death caused by the plague."

"The Challenge of Regenerative Medicine" outlines the ethical questions raised by the effort under way in all medical fields to regenerate human tissue as a means of treating degenerative diseases. "In the future, regenerative medicine may therefore touch most of our lives," writes Leen Trommelmans, PhD, who teaches ethics and philosophy to nursing, midwifery, and facility management students at KaHO Sint-Lieven in Belgium and does research at the Centre for Biomedical Ethics and Law at Catholic University in Leuven. So far, bioethics has focused on the use of stem cells in regenerative medicine, but other questions remain unexamined, including the rights of donors whose cells are used, the availability of costly regenerative treatments to those who cannot afford them, and the prospects of using regenerative medicine for enhancement, such as the prevention of aging.

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