Is There an Ethicist in the House On the Cutting Edge of Bioethics

In this timely book, Jonathan D. Moreno takes up some of the most important questions in clinical ethics today. Moreno's view is that moral values emerge out of human experience, a view that creates a compelling conceptual framework for bioethics.

To begin, Moreno recalls his experience as a hospital ethicist and how that shaped his understanding of what bioethics is about, both as theory and practice. His focus then turns to a difficult moral paradox: the need to advance medical knowledge by using human beings in research. His account of the way American medicine has reached a strong protectionist approach to managing this paradox leads to discussions of vulnerable groups whose circumstances demand that we reflect on the way this issue should be approached in the future.

Moreno then takes up the historical and ethical role of the national security dimensions of human experimentation. His account casts a drastically different light on the origins of modern bioethics, especially on the central document of modern human experimentation, the Nuremberg Code.

In the last section, Moreno pushes the bioethics envelope in a naturalistic examination of emerging values concerning the neurosciences and bioterrorism.

Is There an Ethicist in the House? tackles difficult issues with clarity and insight. The book will be welcomed not only by medical professionals but also by lay readers who seek to understand the philosophical foundations of contemporary medical ethics.

"As Moreno describesby 1900 there were already good examples of ethical research practice, including the basics of informed consent, for instance by US Army General Walter Reed and in Prussia, thanks to government regulation in response to unethical vaccine research. But the ensuing 20th century saw atrocities committed in the name of research, notably by Nazi doctors but also by the US Public Heath Service (in the case of the Tuskegee syphilis studies) and other US medical researchers." -- Indiana University Press

"In this timely collection of writings, Jonathan Moreno demonstrates the maturity of the field of bioethics.." --Metapsychology Indiana University Press

"[This] book tenders a conceptual framework for practical bioethics.... The analysis is both straightforward enough for the interested reader without a doctorate as it is complex enough to intrigue professionals in the field. [Moreno] leaves no doubt regarding his positions as well as his reservations and so offers a useful teaching tool for the instructor interested in balancing perspectives on issues or for the practitioner seeking guidance." --The American Journal of Bioethics Indiana University Press Indiana University Press

"The question Is there a physician in the house? is easy to answer. However, the seemingly parallel question Is there an ethicist in the house? is at once both jarring and provocative. This latter question serves as the focal point for Moreno's naturalistic investigation into the role and risks of being an ethicist employed in a biomedical or clinical setting. Moreno's approach is naturalistic through being historically indebted to the American pragmatism of William James and John Dewey. More directly, Moreno (Univ. of Virginia) admits that his naturalism is evident by reference to... personal and professional experience, a case-oriented approach, and an emphasis on historical inquiry in making sense of current circumstances and judgments. This relatively short but highly engaging work is packed with poignant theory and realistic practice. It includes careful definitions of key terms and rich discussions of issues ranging from the function of and decision making by ethics committees, to research on human subjects, truth telling, and neuroethics. Moreno begins his book with the claim that this volume is... not an introduction to bioethics so much as a re-visioning of the field. By the end, he has not only offered this revisioning, but may also have succeeded in revitalizing the discipline. Summing Up: Highly recommended. Upper-level undergraduates and above.--H. Storl, AugustanaCollege (IL)" --Choice

"Moreno also usefully reminds readers of Stephen Toulmin's observation at the very beginning of the new field: talking too much about ethical theories can make reaching a consensus more difficult and thus is counterproductive to seeking a practical solution to a pressing problem. In such ways bioethics differs dramatically from philosophy the home discipline of so many of its progenitors" -- Indiana University Press

"Forming consensus does not mean reaching unanimity on a single conclusion to a debate so much as arriving at an outcome everyone can live with after full discussion by all parties. As Moreno puts it, consensus is not the goal of deliberation but a precondition for it. A good ethics committee works because its members have open minds, and each member may speak without interruption or intimidation. Ethics committee members, he asserts, should not be chosen as representatives of various parts of the hospital organization nor, when serving, act as representatives of a department (or, for that matter, of a religion or political party)." -- Indiana University Press

"The first six of the book's 15 chapters address bioethics as a profession. These essays include insightful observations about the gradual acceptance of bioethics as a fiel" --in medical education, postgraduate medical education, and hospital bedside consultation. In this realm, Moreno is best known for his discussion of the role of consensus in a pluralistic society and the meaning of consensus in bioethics. Indiana University Press

"Is There an Ethicist in the House? has many virtues. Not only is it an excellent overview of bioethics, both for the general informed reader and for students, each chapter in the book is presented by someone whose life as one of the leading bioethicists in the field touches and is touched by the topics he is describing." --Contemporary Psychology, PSYCHcritique

"The middle five chapters address ethical issues in medical research. Although they contain occasional redundanciesmost readers will find them among Moreno's most informative and provocative essays. While we might think that progress in protecting human research participants has been steady, albeit slow, its history, as Moreno carefully documents, in fact has been erratic. Many readers will be surprised at how quickly the lessons learned after a human tragedy are forgotten, usually under pressure of war or the perceived threat of war." -- Indiana University Press

Takes up some of the most important topics in clinical ethics today, including the ethics of human experimentation and an examination of emerging values concerning the neurosciences and bioterrorism.

Jonathan D. Moreno is Kornfeld Professor and Director of the Center for Biomedical Ethics at the University of Virginia and a Fellow at the Center for American Progress. He has been a senior staff member for two presidential commissions and an advisor to the White House Office of Science and Technology Policy, the National Institutes of Health, the Department of Health and Human Services, the National Academy of Sciences, and the Howard Hughes Medical Institute. Moreno is past president of the American Society for Bioethics and Humanities. He lives in Washington, D.C.

Introduction: "Is There a Philosopher in the House?"

List of Abbreviations

I. A Hospital Philosopher

Introduction

1. Is There an Ethicist in the House?

2. Call Me Doctor? Confessions of a Hospital Philosopher

3. Arguing Euthanasia

II. Naturalizing Bioethics in Theory and Practice

Introduction

4. Bioethics Is a Naturalism

5. Ethics Consultation as Moral Engagement

6. Ethics by Committee: The Moral Authority of Consensus

III. Human Use

Introduction

7. Goodbye to All That: The End of Moderate Protectionism in Human Subjects Research

8. Convenient and Captive Populations

9. Regulation of Research in the Decisionally Impaired

IV. The Meanings of Nuremberg

Introduction

10. "The Only Feasible Means": The Pentagon's Ambivalent Relationship with the Nuremberg Code.

11. Reassessing the Influence of the Nuremberg Code on American Medical Ethics

V. New Directions

Introduction

12. Cancer, Truth, and Genetics

13. Neuroethics: An Agenda for Neuroscience and Society

14. Bioethics after the Terror

15. Another Impossible Profession

Acknowledgments

Credits

Bibliography

Index