The Obligation of Engagement.

As many in the United States feel a need to take a side in the ongoing culture wars, the people who make up the field of bioethics have an obligation to directly engage with those who hold different political views. If bioethics is an academic field, it must also affirm the overall values of the academy to continually challenge central assumptions. If the field wishes to be a part of the development of public policy, it must be able to construct such policies that in some fundamental manner honor the values of the opposition.

Reflecting on the Pathography.

This essay looks at the liminal genre of the critical pathography, a literary form that bridges the boundary between an academic analysis and an illness narrative. It argues that when this genre is compared to more traditional forms of analysis in the medical humanities and bioethics, the critical pathography treats its subject in a manner that is more akin to what Gabriel Marcel refers to as a mystery, something that can only be explored, than to a problem, a puzzle that can be solved.

Toward the Polyphonic Case.

Can one publish a bioethics case ethically? I suspect that most in bioethics would feel comfortable publishing a case if the subject-the patient-gave explicit permission, the amount of biographical information revealed was under the control of the subject, and the subject fully understood the benefits and risks of publishing the case. Some might add that the subject should have a chance to approve the final representation. I think that the ethics of publishing cases needs to be rethought. And this rethinking needs to be focused not on the way publishing a case might harm a patient (that is, nonmaleficence) but, rather, on how a case presentation does not convey the patient's own voice in the narrative (that is, respect for autonomy). Bioethics needs a new model of case presentation: the polyphonic case, which demands that the subject be a part of the case's construction.

On Cute Monkeys and Repulsive Monsters.

When I heard that a laboratory in China had cloned two long-tailed macaques, I thought of Mary Shelley's novel Frankenstein. When academics write about the novel, many point out that the reason the creature becomes a "monster" is not that he has any inherently evil qualities but that Victor Frankenstein, the creature's "mother," immediately rejects him. All later problems can be traced to the fact that Frankenstein does not take responsibility for his creation. While I do not disagree with this, we need to think beyond (or before) Frankenstein's rejection to the reason he rejects it. I would like to suggest that this reason reveals something about how bioethics judges new biological technologies. I suggest that what causes Frankenstein to feel revulsion toward his creation is its unsettling mix of the beautiful and the ugly.

Telos versus Praxis in Bioethics.

The authors of "A Conceptual Model for the Translation of Bioethics Research and Scholarship" argue that bioethics must respond to institutional pressures by demonstrating that it is having an impact in the world. Any impact, the authors observe, must be "informed" by the goals of the discipline of bioethics. The concept of bioethics as a discipline is central to their argument. They begin by citing an essay that Daniel Callahan wrote in the first issue of Hastings Center Studies. Callahan argued in this 1973 piece that bioethics had yet to attain the status of a discipline, and he lauded the freedom of being able to define a new discipline. Callahan's essay shares with Mathews and colleague's a peculiarity: neither ever defines what it means to refer to something as a "discipline." To define a discipline does mean attending to the intended end product of scholarly activity, so I concur with Mathews et al.'s focus on outcomes. But I am concerned that in their argument they confusingly entangle their understanding of an academic discipline's internal goals, its telos, with its potential to have an impact on the external world, its praxis. The confusion that this can bring exposes what I believe is a profound problem within bioethics, the discipline's peculiar and at times intellectually hazardous relationship with its institutional hosts.

Root Metaphor and Bioethics.

While a substantial amount of work has been done on the metaphors used in bioethics (such as the body as "property" or the ethics consultant as "engineer"), this essay focuses on the manner in which metaphors reside at the core of various bioethics theories. Drawing upon Stephen Pepper's (1942) notion that philosophical positions are expressions of specific "root metaphors" (similarity, machine, organism, act), the essay will look at the way theories such as principlism, rule-based ethics, casuistry, and phenomenological ethics are also grounded in particular root metaphors. These root metaphors express fundamentally different notions of the way the world operates, and thus arguments over the superiority of particular moral theories are actually disagreements over worldviews and cannot be resolved through rational discourse. To agree with an alternative theory would entail the adoption of a fundamentally different root metaphor for understanding the way the world works.

Taking bioethics personally.

This narrative symposium examines the relationship of bioethics practice to personal experiences of illness. A call for stories was developed by Tod Chambers, the symposium editor, and editorial staff and was sent to several commonly used bioethics listservs and posted on the Narrative Inquiry in Bioethics website. The call asked authors to relate a personal story of being ill or caring for a person who is ill, and to describe how this affected how they think about bioethical questions and the practice of medicine. Eighteen individuals were invited to submit full stories based on review of their proposals. Twelve stories are published in this symposium, and six supplemental stories are published online only through Project MUSE. Authors explore themes of vulnerability, suffering, communication, voluntariness, cultural barriers, and flaws in local healthcare systems through stories about their own illnesses or about caring for children, partners, parents and grandparents. Commentary articles by Arthur Frank, Bradley Lewis, and Carol Taylor follow the collection of personal narratives.