ABSTRACT:It may be too late to avoid the climate crisis, likely to be humanity's most expensive, widespread, and enduring catastrophe. This is a qualitatively different kind of catastrophe, in which increased costs, decreased revenue, and no possibility of bailout force communities to harshly cut budgets, especially in health care. Little is known about making such brutal cuts fair or efficient, nor how to help the public accept them. The crisis presents an opportunity for bioethicists to play a crucial role, but (...) one for which traditional approaches are inherently inadequate. Although often dismissed as heartless, Garrett Hardin's "lifeboat ethics" started a conversation about making ethical choices in global disasters—where all options are painful and unacceptable—and may provide guidance. Bioethics during the climate crisis must focus on communities rather than individuals and help survivors grieve the terrible consequences. Because today's choices will affect many generations, with the burdens falling most heavily on poor communities, we have to construct a radical bioethics to help tomorrow's health care become green, efficient, and fair. (shrink)

Volume 20, Issue 7, July 2020, Page 101-103.

Legal minds have utilized the principle of double effect as proposed by St. Thomas Aquinas for centuries to shape legal authority in cases where moral judgment and legal reasoning meet. The U.S. Supreme Court had uti­lized double-effect reasoning in the realm of self-defense cases. This article discusses more recent use of double-effect reasoning in the landmark Supreme Court case Vacco v. Quill and its companion case, Washington v. Glucksberg. Chief Justice William Rehnquist, writing for the Court in Vacco, introduced double-effect (...) reasoning to identify the distinctions between palliative care and assisted suicide in an effort to uphold the constitutionality of the ban on assisted suicide in New York. National Catholic Bioethics Quarterly 11.1 (Spring 2011): 41–48. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S21-S23, March‐April 2022.

ABSTRACTThere is a growing body of literature describing conceptual frameworks for working with participatory visual methods. Through a global health lens, this paper examines some key themes within these frameworks. We reflect on our experiences of working with with an array of PVM to engage community members in Vietnam, Kenya, the Philippines and South Africa in biomedical research and public health. The participants that we have engaged in these processes live in under-resourced areas with high prevalence of communicable and non-communicable (...) diseases. Our paper describes some of the challenges that we have encountered while using PVM to foster knowledge exchange, build relationships and facilitate change among individuals and families, community members, health workers, biomedical scientists and researchers. We consider multiple ethical situations that have arisen through our work and discuss the ways in which we have navigated and negotiated them. We offer our reflections and learning from facil... (shrink)

There are some long-standing social issues that imperil Black Americans’ relationship with health and healthcare. These issues include racial disparities in health outcomes, provider bi...

*The views expressed are the author's own and should not be construed as representing the policies and opinions of the American Medical Association.

We seek to bring Black bodies and lives into full view within the enterprise of Indigenous health research to interrogate the unquestioned good that is taken to characterize contemporary Indigenous health research. We articulate a Black bioethics that is not premised upon a false logic of beneficence, rather we think through a Black bioethics premised upon an unconditional love for the Black body. We achieve this by examining the accounts of two Black mothers, (...) fictional and factual rendering visible the racial violence Black bodies have been subjected to. We call for a Black bioethics that reimagines the Black body as beautiful and belonging—to both someone and somewhere. (shrink)

The impact of machine learning in healthcare on patient informed consent is now the subject of significant inquiry in bioethics. However, the topic has predominantly been considered in the context of black box diagnostic or treatment recommendation algorithms. The impact of machine learning involved in healthcare resource allocation on patient consent remains undertheorized. This paper will establish where patient consent is relevant in healthcare resource allocation, before exploring the impact on informed consent from the introduction of black (...) box machine learning into resource allocation. It will then consider the arguments for informing patients about the use of machine learning in resource allocation, before exploring the challenge of whether individual patients could principally contest algorithmic prioritization decisions involving black box machine learning. Finally, this paper will examine how different forms of opacity in machine learning involved in resource allocation could be a barrier to patient consent to clinical decision-making in different healthcare contexts. (shrink)

This paper describes a network of three interconnected, multidisciplinary research projects designed to investigate environmental health issues faced by First Nations in Canada. These projects, developed in collaboration with academia, used a participatory approach meant to build capacity, raise awareness, and initiate change. The first project, which began in British Columbia in 2008, gathered information on the traditional diet; for example, its composition, nutritional quality, and potential for chemical exposure. This 10-year, Canada-wide project served as a model for two follow-up (...) projects: one on biomonitoring and another on indoor air quality. All three projects provided community ownership over the data and communicated results in a culturally sensitive manner to encourage interest in research and initiate risk reduction activities. The Assembly of First Nations, a national advocacy organization representing over 630 First Nations communities across Canada, participated in all aspects of the research while coordinating communications and arranging timely dissemination of results. These projects showed how properly executed, community-based research can be a valuable tool for stimulating interest in scientific studies while promoting self-reliance, components often missing from academic research. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S3-S11, March‐April 2022.

Womanist Bioethics introduces a practical framework to address health disparities and inequities, arguing that doing justice to Black women's bodies entails understanding health and vulnerability as cultural productions, thus implicating medical, policy-making, economic and religious institutions in the Black women's health crisis.

Hastings Center Report, Volume 52, Issue S1, Page S63-S65, March‐April 2022.

Hastings Center Report, Volume 52, Issue S1, Page S57-S59, March‐April 2022.

Background Non-therapeutic trials in which terminally ill cancer patients are asked to undergo procedures such as biopsies or venipunctures for research purposes, have become increasingly important to learn more about how cancer cells work and to realize the full potential of clinical research. Considering that implementing non-therapeutic studies is not likely to result in direct benefits for the patient, some authors are concerned that involving patients in such research may be exploitive of vulnerable patients and should not occur at all, (...) or should be greatly restricted, while some proponents doubt whether such restrictions are appropriate. Our objective was to explore clinician-researcher attitudes and concerns when recruiting patients who are in advanced stages of cancer into non-therapeutic research. Methods We conducted a qualitative exploratory study by carrying out open-ended interviews with health professionals, including physicians, research nurses, and study coordinators. Interviews were audio-recorded and transcribed. Analysis was carried out using grounded theory. Results The analysis of the interviews unveiled three prominent themes: 1) ethical considerations; 2) patient-centered issues; 3) health professional issues. Respondents identified ethical issues surrounding autonomy, respect for persons, beneficence, non-maleficence, discrimination, and confidentiality; bringing to light that patients contribute to science because of a sense of altruism and that they want reassurance before consenting. Several patient-centered and health professional issues are having an impact on the recruitment of patients for non-therapeutic research. Facilitators were most commonly associated with patient-centered issues enhancing communication, whereas barriers in non-therapeutic research were most often professionally based, including the doctor-patient relationship, time constraints, and a lack of education and training in research. Conclusions This paper aims to contribute to debates on the overall challenges of recruiting patients to non-therapeutic research. This exploratory study identified general awareness of key ethical issues, as well as key facilitators and barriers to the recruitment of patients to non-therapeutic studies. Due to the important role played by clinicians and clinician-researchers in the recruitment of patients, it is essential to facilitate a greater understanding of the challenges faced; to promote effective communication; and to encourage educational research training programs. (shrink)

February is Black History Month and so healthcare practitioners will soon rummage history books for information about famous African Americans, like Onesimus, the African slave who...

In this article, I begin by describing what I call this Black Lives Matter moment in the US. I then offer three reasons for considering racism as a bioethical issue, the least discussed of which is the way in which racism acts as a barrier to the creation of better healthcare systems. Next, I argue that the concept of race itself constitutes a bioethical issue in a way that is not fully reducible to racism. Finally, I discuss how we, (...) both bioethicists and health care professionals, might meet this moment by identifying individual points of responsibility (beyond liability) for structural injustice. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S66-S68, March‐April 2022.

Hastings Center Report, Volume 52, Issue S1, Page S89-S89, March‐April 2022.

Hastings Center Report, Volume 52, Issue S1, Page S79-S82, March‐April 2022.

The birth of modern gynecology in the USA is preceded by experimental exploitations of Black women’s bodies in the mid-nineteenth century, entailing a long-drawn extraction of “reproductive knowledge” from enslaved patients. Charly Evon Simpson’s Behind the Sheet (2019) stages the history of medical bondage of Black enslaved women in antebellum South, reconstructing the events that led to the surgical innovation for vesico-vaginal fistula. Scrutinizing Simpson’s dramatization of the event, this paper prompts inquiries into the interplay of power and (...) consent between the physician and the enslaved patient in plantation healthcare, highlighting the need to reexamine bioethical principles. Using the theoretical framework of medical gaze propounded by Foucault and further developed by Susan Greenhalgh, the paper analyzes the operation of white patriarchal power and the construction of physician heroism in the medical sphere. Investigating the realm of bodily autonomy in the context of medical bondage, the paper attempts to render a “herstorical” standpoint on the contributions of enslaved Black women to the field of gynecology. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S60-S62, March‐April 2022.

Mental health apps bring unprecedented benefits and risks to individual and public health. A thorough evaluation of these apps involves considering two aspects that are often neglected: the algorithms they deploy and the functions they perform. We focus on mental health apps based on black box algorithms, explore their forms of opacity, discuss the implications derived from their opacity, and propose how to use their outcomes in mental healthcare, self‐care practices, and research. We argue that there is a relevant (...) distinction between functions performed by algorithms in mental health apps, and we focus on the functions of analysis and generation of advice. When performing analytic functions, such as identifying patterns and making predictions concerning people's emotions, thoughts, and behaviors, black box algorithms can be better than other algorithms to provide information to identify early signs of relapse, support diagnostic processes, and improve research by generating outcomes that lead to a better understanding of mental health. However, when carrying out the function of providing mental health advice, black box algorithms have the potential to deliver unforeseen advice that may harm users. We argue that the outcomes of these apps may be trustworthy as a complementary source of information, but express caution about black box algorithms that give advice directly to users. To reap the benefits of mental health apps based on black box algorithms and avoid unintended consequences, we critically need to know whether these algorithms are fulfilling the function of providing mental health advice. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S18-S21, March‐April 2022.

Hastings Center Report, Volume 52, Issue S1, Page S39-S41, March‐April 2022.

In the September-October 2001 issue of the Hastings Center Report, editor Gregory Kaebnick encouraged bioethicists to turn their attention toward “easily overlooked, relatively little-talked-about societal topics” such as race. In 2000 the president of the American Society for Bioethics had called for a more socially conscious bioethics. Race was risky territory, Kaebnick pointed out, but this challenge did not justify avoidance. Over the next fifteen years, the response to this editor's invitation to examine the racial dimensions of medicine (...) in the Report was limited both in quantity and in terms of the range of topics covered. All told, the bioethics community has not responded to the editor's call for bioethicists to engage with the racial dimension of medicine, and the Report has not really come through on the tacit commitment made in 2001. The lack of interest in race matters evidenced in the Report as well as the American Journal of Bioethics has also prevailed in medical humanities journals, whose few pieces on race have tended to remove race relations from our current realities in two ways: some articles locate medical racism in the American past or in colonial Africa, while others analyze the medical disorders of fictional characters. Bioethicists have not embraced the opportunity to create a sociologically and historically informed bioethics that might be applied to the lives of black Americans and their unending health crisis. (shrink)

Without doctors being able to explain medical decisions to patients, I argue their use of black box AIs would erode the effective and respectful care they provide patients. In addition, I argue that physicians should use AI black boxes only for patients in dire straits, or when physicians use AI as a “co-pilot” (analogous to a spellchecker) but can independently confirm its accuracy. I respond to A.J. London’s objection that physicians already prescribe some drugs without knowing why they (...) work. (shrink)

Using the example of Black people’s inequitable COVID-19 outcomes and their health outcomes prior to the pandemic, I argue that the pandemic has forever changed how we should think about the conceptual and practical nature of health equity. From here on, we can no longer think of health equity without the concept of intersectionality. In particular, we must acknowledge that discrimination (e.g. sexism, ableism, racism, classism, etc.) within our social institutions intersect to withhold resources needed for health from people (...) who themselves have intersecting identities that make them vulnerable to the effects of discrimination. To ignore intersectionality in our work on health equity would mean ignoring a great injustice imposed on some of the most overlooked people in our communities, which would also be a great disserve to bioethics’ professional longevity. (shrink)

This chapter shows that feminist bioethics begins with critical engagement. Feminist bioethics as perspective centers the experiences of women – women's health, challenges that women primarily face within health care contexts, gaps in research that are only understood as gaps when one takes women seriously as women. The chapter highlights a few significant breakthroughs in feminist theory broadly that have informed feminist bioethics as perspective and as methodology – standpoint theory, relational autonomy, and intersectionality – in order (...) to show how an intentionally feminist lens can improve bioethics for everyone. Feminists understood that healthcare generally, and bioethics, in particular, were important sites for feminist thought. The traditional view of autonomy in bioethics is centered on the individual. The chapter also highlights an example of public practice, The Black Mamas Matter Alliance, that shows the important work of Black women's community advocacy as a blueprint for a public feminist bioethics. (shrink)

Recent years have witnessed intensive efforts to specify which requirements ethical artificial intelligence (AI) must meet. General guidelines for ethical AI consider a varying number of principles important. A frequent novel element in these guidelines, that we have bundled together under the term explicability, aims to reduce the black-box character of machine learning algorithms. The centrality of this element invites reflection on the conceptual relation between explicability and the four bioethical principles. This is important because the application of general (...) ethical frameworks to clinical decision-making entails conceptual questions: Is explicability a free-standing principle? Is it already covered by the well-established four bioethical principles? Or is it an independent value that needs to be recognized as such in medical practice? We discuss these questions in a conceptual-ethical analysis, which builds upon the findings of an empirical document analysis. On the example of the medical specialty of radiology, we analyze the position of radiological associations on the ethical use of medical AI. We address three questions: Are there references to explicability or a similar concept? What are the reasons for such inclusion? Which ethical concepts are referred to? (shrink)

When we go to the doctor, he or she will not begin to treat us without taking our history – and not just our history but that of our parents and grandparents before us. The doctor will not see us u...

The article highlights the potential that African and Black Philosophy can contribute towards the debates on human dignity. It facilitates a three-way philosophical conversation among the Western, African, and Black conceptions of human dignity. It is motivated by the skepticism in the African and Black approaches to ethics that reject the view that some ontological capacity can ground intrinsic value, or human dignity. The article distinguishes the merit-based (the African and Black Philosophy) from the capacity-based approaches (...) (the Western philosophy) to human dignity. In light of the comparisons among the three theories of human dignity, the article identifies three important lessons for moral-political philosophy. First, the Western conception of human dignity needs to explain and justify grounding of value on a descriptive feature. Secondly, the Black conception of dignity is a version of virtue-based account of it, which places a prime on resistance and struggle against domination. Finally, the capacity-based approach seems to have moral-theoretic advantages in dealing with issues in bioethics, environmental ethics, and political philosophy, which the African and Black conceptions of human dignity seems not to have. (shrink)

Race and religion are integral parts of bioethics. Harm and oppression, with the aim of social and political control, have been wrought in the name of religion against Blacks and people of color as embodied in the Ten Commandments, the Inquisition, and in the history of the Holy Crusades. Missionaries came armed with Judeo/Christian beliefs went to nations of people of color who had their own belief systems and forced change and caused untold harms because the indigenous belief systems (...) were incompatible with their own. The indigenous people were denounced as ungodly, pagan, uncivilized, and savage. Hence, laws were enacted because of their perceived need to structure a sense of morality and to create and build a culture for these indigenous people of color. To date bioethics continues to be informed by a Western worldview that is Judeo/Christian in belief and orientation. However, missing from bioethical discourse in America is the historical influence of the Black Church as a cultural repository, which continues to influence the culture of Africans and Blacks. Cultural aspects of peoples of color are still largely ignored today. In attempting to deal with issues of race while steering clear of the religious and cultural impact of the Black Church, bioethics finds itself in the middle of a distressing situation: it simply cannot figure out what to do with race. (shrink)

As a Black bioethicist whose primary area of expertise is anti-Black racism’s influence on our health, I read articles calling on bioethics to do a better job of promoting anti-racist principles an...

Black women and their babies matter. In this commentary, we explore the current challenges that Black women face when pregnant and what is needed to ensure an anti-racist approach to prenatal and p...

Facilities that emit hazardous toxins, such as toxic landfills, oil refineries, and chemical plants, are disproportionately located in predominantly Black, Latinx, and Indigenous neighborhoods. Environmental injustices like these threaten just distribution of health itself, including access to health that is not dependent on having the right skin color, living in the right neighborhood, or making the right amount of money. Facilities that emit environmental toxins wrongly make people's race, ethnicity, income, and neighborhood essential to who is allowed to breathe (...) clean air and drink clean water, and thus, who is allowed to be healthy. This can be seen in the environmental crises in Louisiana; Mississippi; Houston, Texas; and Flint, Michigan. Since bioethics purports to concern itself with the principle of justice as applied to individuals and increasingly to populations, the field ought to concern itself more with environmental injustice. (shrink)

Black people experience lower quality and lesser quantity of sleep than white people. Researchers, however, do not believe that racial disparities in sleep sufficiency are caused by biological differences, but rather by various social differences, such as differences in sleeping environments and socioeconomic status. Racial disparities in sleep sufficiency are a matter of social justice because sleep is important to mental and physical health, meaning racial disparities in sleep sufficiency can contribute to unequal and unjust disparities in overall health. (...) Racial disparities in sleep may also be linked to other racial disparities in health that black people disproportionately experience such as hypertension and obesity. Sleep hygiene, common therapeutic advice given to help induce sleep, is often the first step to helping people sleep. Sleep hygiene, however, does not address the social, legal, cultural, and economic causes of racial disparities in sleep sufficiency. Sleep hygiene, as an ideal theory, addresses sleeplessness under ideal circumstances, only which a small group of privileged people live. Sleep hygiene ignores the unequal circumstances that contribute to some black people’s sleeplessness. Nonideal theory, however, acknowledges the less than ideal circumstances of certain groups, including people of color, and gives us a framework to develop solutions to racial disparities in sleep sufficiency. (shrink)

Hastings Center Report, Volume 52, Issue S1, Page S83-S88, March‐April 2022.

The domains of religious doctrine and practice provide ground for double bind analysis, particularly as applied to race, religion, and bioethics. In these spheres, reconciling church doctrine with social or medical practice is often challenging; the demands from each sphere are unique and sometimes irreconcilable. This chapter uses double bind theory as a framework to engage in a dialogue concerning race, religion, and bioethics. It offers a dialogue that scrutinizes conservative religious thought in what is colloquially known as (...) the “black church” regarding the challenges of medical ethics and race. (shrink)

ABSTRACTThis commentary responds to genetic testing of African ancestry through a series of personal narratives that reveal a complex, intimate, and individualised process of identity formation. The author discusses both how her family and others outside her family have fostered and challenged her sense of black identity. She concludes by maintaining that racial identity is not in the genes but in the world in which we live and the stories we construct and are able to maintain.