While there are no doubt ethical principles and concepts that extend across all aspects of bioethics, it is now becoming common to find separate treatments of specialty fields emerging in the bioethics literature and in clinical ethics areas of specialization. In most academic fields and interdisciplinary areas of study, it is not uncommon to find scholars and practitioners focusing on developing particular areas of specialty. What is fairly unique about bioethics, however, is that we find that its speciality areas are not just reconceiving central disciplinary questions or using different ways of looking at issues but are bringing to light the importance of examining the ethical issues specific to their areas of clinical and research practice.
It will always be the case that considerations such as informed consent, confidentiality, minimizing harm, and priority setting, among other considerations, will be central ethical issues that clinicians will confront in all areas of practice. Nevertheless, the development and study of various speciality fields of bioethics places us in a better position to be able to give a more nuanced and pertinent analysis of the distinctive ethical issues faced by particular clinical areas of practice, especially where the traditional application of overarching ethical theory or bioethical methodologies may have been found to be limiting.
The chapters in this section provide an overview of the most pressing and relevant ethical issues unique to their clinical speciality. For instance, in Ch. 57, Gail Van Norman examines the distinctive ethical issues that arise because anesthesia routinely alters the patient’s consciousness, sometimes affecting a patient’s competence and autonomy, and that there are instances where anesthesiologists can be expected to use their knowledge and skills to abolish patient resistance. These issues are made stark in her examination of the special role of anesthesiologists in participating in state executions (in jurisdictions where it is required by law) and in upholding do-not-resuscitate orders in the operating room. Similarly, in Ch. 64, Margaret Eaton examines the singularity of ethical issues faced in pharmacy practice by virtue of several facts. For example, pharmacists are one step removed from the diagnostic aspect of the therapeutic encounter and are usually the last healthcare professional the patient has contact with before drug treatment commences. Numerous issues also arise from the fact that pharmacists often control the drug formulary in healthcare institutions.
Some areas of specialization within bioethics will be driven by scientific progress and technological advancement. For example, the specialty area of neuroethics has recently exploded and we find the ethical issues surrounding the brain, mind, and consciousness becoming one of the predominant areas in bioethics literature and ethical issues that are discussed more widely outside of clinical medicine. In Ch. 63, Eric Racine and Judy Illes discuss the importance of the ethical issues surrounding clinicians acting as gatekeepers in the marketing of neuroimaging and therapeutic products to treat neurological and psychiatric diseases.
Other areas of specialization within bioethics are driven by immediate societal threats that require prompt and effective responses. For instance, with the increase threat of pandemics and bioterrorism, we have seen rapid development of treatment and institutional structures related to infectious diseases. In Ch. 61, Jay Jacobsen examines the distinctive ethical tension that arises in the practice of infectious disease medicine between respecting patient preferences and preventing harm to others in society.
There will also be times where the development of different areas of bioethics specialization will depend on factors surrounding the expanding scope of what constitutes medical care. For instance, in Ch. 65, Michael Cohen examines how the integration of therapies such as acupuncture, chiropractic, herbal medicine, massage therapy, and so on concurrent to conventional medical therapies presents new ethical challenges with respect to whether and how clinicians should acknowledge a pluralistic foundation of healthcare that contains multiple modes of legitimate therapeutic interventions.
We additionally have chapters on emergency and trauma medicine (Ch. 59), critical and intensive care medicine (Ch. 58), surgery (Ch. 56), psychiatry (Ch. 62), and primary care (Ch. 60). All these provide both a basis from which to explore further developments in specialty fields of bioethics and, for clinicians who work with colleagues in these specialties, a better understanding of how the clinical issues specific to their area of practice presents and informs the ethical issues they must deal with on a daily basis.