Jennifer Flynn

There is some question whether bioethicists should use standard moral theory in approaching the questions and problems of bioethics. This opens the door to a broader set of questions concerning which approaches, or methods, are best suited to bioethics. This entry begins with a discussion of accounts of what constitutes a moral theory, and the nature of bioethics as a field (Section One). This includes whether bioethics is properly considered a version of applied ethics (Section Two). Section Three covers discussions of the benefits and drawbacks of using standard moral theories (such as utilitarianism and deontology) to address bioethical issues. Section Four considers an alternative to standard theory, Beauchamp and Childress’ principles-based approach. Section Five sets out two further methods of bioethics, casuistry and narrative ethics. Feminist approaches to bioethics are reviewed in Section Six. Section Seven explores the use of moral theory within the context of clinical ethics.

Drug shortages are not new; they have been managed through conservation, procurement of alternatives, and redistribution of stock. The Sandoz shortage in 2012 has caused a radical reduction of generic injectables. In Newfoundland and Labrador, our response has led to the development of the framework, structure, and process outlined in this paper. The efforts have eased the concerns of clinicians and leaders, as they are aware of the decision-making resource for situations of drug and technology shortage.

Facial transplantation is becoming increasingly accepted as a method of reconstructing otherwise unreconstructable adult faces. As this modality is made more available, we must turn our attention to pediatric patients who may benefit from facial transplantation. In the current article, the authors present and briefly examine the most pressing ethical challenges posed by the possibility of performing facial transplantation on pediatric patients. Furthermore, they issue a call for a policy statement on pediatric facial transplantation. The present article may serve as a first step in that direction, highlighting ethical issues that would need to be considered in the creation of such a statement.

Within discussions of the professionalization of healthcare ethics consultants (HECs), there is concern about the appropriate training of future HECs. This training is to be geared toward a set of core competencies. One category of such competencies, competences relating to attributes, attitudes, and behaviours, poses certain challenges, since it is difficult to know how to educate someone into having the relevant attributes and attitudes. Here I argue that guidance can be found in work in philosophy and literature. I first show that this work illustrates two useful points: that literature demands of its reader a certain moral attention, and that literature cultivates that attention as it demands it. I then apply these insights to this category of core competencies and to the question of how to educate for them. This provides further justification for the list of desirable attributes and attitudes as it stands and provides impetus to build up on it. It also allows for concrete suggestions about how these attributes and attitudes might be best cultivated through education.

Vascularized Composite Allotransplantation (VCA) enables improved function and quality of life for those who have lost anatomical parts such as a limb and the relief of profound suffering for those with severe facial disfiguration. VCA differs from vital organ transplantation in two important ways: (1) these transplants are not necessary for recipient survival, impacting risk-benefit ratios; and (2) face and limb transplants are visible and touchable, leading to issues of identity changes, social interaction and psychological adjustments. This chapter will consider the ethical implications of VCA in pediatrics. This chapter will be divided into the following six sections: (1) introduction; (2) the state of the science and experience with VCA; (3) risk-benefit assessment; (4) informed consent (i) donors and donor surrogate decision makers (ii) recipients and recipient surrogate decision makers; (5) establishing a pediatric program (i) recipient selection (ii) allocation; (iii) accountability for surgical innovation and (6) conclusion.

What kind of criticism does the term ‘moralism’ make? In this paper, I examine whether clinical ethics consultation is even moralistic, and the relevance to this question of the moral expertise of the clinical ethicist. More specifically, I pose two questions: why might clinical ethics consultation sometimes be perceived as moralistic, and does clinical ethics consultation ever require a certain kind of moralism? I begin by looking at the term moralism, providing an exposition of some relevant philosophical work. Moving to clinical ethics, I examine two concerns about clinical ethics, concerns at least partly underwritten by worries about moralism. I then address the issue of the perception of moralism in clinical ethics consultation, and suggest that the clinical ethics consultant’s moral expertise can (and ought to) reduce that perception. Finally, I examine the requirement of clinical ethics consultation of a certain kind of moralism, this in fact as a result of the clinical ethics consultant’s moral expertise.