A majority opinion seems to have emerged in scholarly analysis of the assortment of technologies that have been given the label “synthetic biology.” According to this view, society should allow the technology to proceed and even provide it some financial support, while monitor­ing its progress and attempting to ensure that the development leads to good outcomes. The near‐consensus is captured by the U.S. Presidential Commission for the Study of Bioethical Issues in its report New Directions: The Ethics of Synthetic Biology (...) and Emerging Technologies, which arguably marked the end of a preliminary round of analysis about the ethical and policy questions raised by synthetic bi­ology. Like a number of other, earlier documents issued by various groups around the world, the re­port called attention to questions about how the technology will be used; whether it might be mis­used; what sorts of accidents might happen along the way; the economic, environmental, and social impacts of the eventual applications; whether the very idea of “synthetic biology” should be trou­bling; and how the debate over all of these ques­tions will be conducted. Also like most similar documents, however, while it called for careful monitoring and oversight of technology, it did not recommend any significant new constraints on its development and use. The commission's stance was that it would be “imprudent either to declare a moratorium on synthetic biology until all risks can be determined and mitigated, or to simply ‘let science rip,’ regardless of the likely risks.”In this report, we will take stock of the current consensus, comment on some of the major points of disagreement, and identify the next steps for the debate. In part I, we offer a brief overview of the research and applications commonly grouped together under the heading of synthetic biology, partly in order to set the stage for the rest of the discussion and partly because we want to highlight some conceptual problems that attend the very la­bel given this field. In parts II, III, and IV, we take up, respectively, three broad classes of concerns that arise in the context of synthetic biology: con­cerns about the intrinsic or inherent value of do­ing synthetic biology, concerns about the concrete harms and benefits of doing synthetic biology, and concerns about justice. Addressing these concerns requires a method for bringing the public's values to bear on policy‐making concerning emerging biotechnologies; in part V, we discuss the chal­lenges in developing such a method. (shrink)

This essay analyzes two types of patient‐experience data to broaden and deepen understanding of trust in health care. Analysis of patients’ open‐ended comments shows a close connection between patients’ feelings of trust and their intent to recommend providers and provider organizations—a global measure to evaluate patients’ perceptions of care experiences. Patients’ comments also reveal the bidirectional building of trust between the patient and the caregiver. Trust gets built when patients perceive their caregivers to trust their knowledge of their bodies as (...) well as when caregivers demonstrate caring behaviors that earn the patients’ trust. Patients’ ratings of a closed‐ended survey item on “confidence in provider” create the greatest differentiation for the global measure of patient experience—whether patients did or did not recommend a practice or provider. The essay also discusses related findings on pre‐visit friction and the use of humor by the caregiver to expand understanding of trust. (shrink)

The marketing of health care services raises the prospect that an ethic of strangers will govern relations between providers and patients. A fiduciary model that emphasizes honesty and public accountability, as well as the patient's good and avoiding unnecessary services, can keep marketing consistent with the ethical tradition of medicine.

Book reviewed in this article: Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth Century England. By Michael MacDonald. Making It Crazy: An Ethnography of Psychiatric Clients in an American Community. By Sue E. Estroff. Mind, Mood, and Medicine: A Guide to the New Biopsychiatry. By Paul H. Wender, M.D. and Donald F. Klein, M.D.

If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.

The editors welcome letters from readers, although we cannot guarantee that all will be published. To ensure timeliness, correspondents must respond to an article within seven weeks and not exceed two double‐spaced pages. Letters become the property of the editors and may be edited and shortened at our discretion.

The editors welcome letters from readers, although we cannot guarantee that all will be published. To ensure timeliness, correspondents must respond to an article within seven weeks and not exceed two double‐spaced pages. Letters become the property of the editors and may be edited and shortened at our discretion.

Book reviewed in this article: Artificial Reproduction: A Social Investigation. By R. Snowden, G.D. Mitchell, and E. M. Snowden. Redefining Human Life: Reproductive Technologies and Social Policy. By Robert H. Blank. Reproductive Ethics. By Michael D. Bayles.

This essay considers the issue of informed consent as it arose in the context of 1960s living kidney donors. In one of the earliest empirical inquiries into informed consent, psychiatrists Carl H. Fellner and John R. Marshall interviewed donors about their decision‐making process and their experience and reflections on donorship. In their much‐cited 1970 paper, the physicians reported that living donors, rather than reaching a reasoned, intellectual, and unemotional decision about donating a kidney (as stipulated in the Ethical Guidelines for (...) Organ Transplantation issued by the American Medical Association's Judicial Council), instead made instantaneous and “irrational” decisions about participation. Fellner and Marshall's studies contributed to the public debate and professional discussion about the moral and ethical dimensions of donorship, even as they challenged the developing consensus on informed consent. (shrink)

Over email a few days after the death of Daniel Callahan, cofounder of The Hastings Center and for many years its director and then president, Joseph Fins, a longtime Hastings colleague, offered this comfort: “[H]enceforth every issue of the Report is a living memorial to Dan the writer, editor, and institution builder.” In the Hastings Center Report's first issue, published in June 1971, Dan stated, “To say that [the work of the Report] must be multi‐disciplinary is only (...) to say the issues [it will address] are as complex as human beings themselves.” This July–August 2019 issue continues the tradition Dan began. An essay by Laura Guidry‐Grimes expands on the importance of interdisciplinary conversations and problem solving—and attends to the complexity of human beings—in recalling a patient who was failed by multiple social institutions. In the lead article, a team of authors led by James Sabin identifies a challenge to conducting ethical research within learning health organizations, where research and care are integrated with the aid of patient data from health insurance providers. (shrink)

It is a thankless task to have to reply to Professor Murray Krieger’s “Retrospective.” Qui s’excuse, s’accuse, and since I cannot ask my readers to embark on their own retrospective of my writings and test them for consistency, I have little chance of restoring my reputation in their eyes. Hence I would have been happier to leave Professor Krieger to his agonizing, if he did not present himself the “spokesman” for a significant body of theorists who appear to have acclaimed (...) my book on Art and Illusion without ever having read it. The followers of this school of criticism—of which Professor Krieger is a prominent member—had apparently convinced themselves that the book lent support to an aesthetics in which the notions of reality and of nature had no place. They thought that I had subverted the old idea of mimesis and that all that remained were different systems of conventional signs which were made to stand for an unknowable reality. True, professor Krieger admits that I never endorsed such an interpretation of my views, and he even concedes that there are passages in Art and Illusion which contradict such an out-and-out relativism, but he wants to convince his readers that these contradictions lead precisely to the ambiguities he now proposes to analyse.If he were right that the book encourages such a misreading, all I could do would be to express my regrets for having failed to make myself sufficiently clear. Luckily I can draw comfort from the fact that unlike these literary critics, the leading archaeologist of this country, Professor Stuart Piggott, had no difficulty at all in discerning my meaning and profiting from my arguments. In his Walter Neurath Memorial Lecture of 1978, entitled Antiquity Depicted: Aspects of Archaeological Illustration, the author did me the honour of taking a statement from my book as his starting point. It is the passage at the end of part I in which I recapitulate the content of the first two chapters:What matters to us is that the correct portrait, like the useful map, is an end product on a long road through schema and correction. It is not a faithful record of a visual experience but the faithful construction of a relational mode.Neither the subjectivity of vision nor the sway of conventions need lead us to deny that such a model can be constructed to any required degree of accuracy. What is decisive here is clearly the word “required.” The form of a representation cannot be divorced from its purpose and the requirements of the society in which the given visual language gains currency.1 1. E. H. Gombrich, Art and Illusion: A Study in the Psychology of Pictorial Representation, A. W. Mellon Lectures in the Fine Arts, 1956 , p. 90. E. H. Gombrich was director of the Warburg Institute and Professor of the History of the Classical Tradition at the University of London from 1959 to 1976. His many influential works include The Story of Art, Art and Illusion, Meditations on a Hobby Horse, The Sense of Order, Ideals and Idols, The Image and the Eye, and, most recently, Tributes. His previous contributions to Critical Inquiry include “The Museum: Past, Present and Future and “Standards of Truth: The Arrested Image and the Moving Eye”. (shrink)

I argue that to be compelled to do routine work is to be gravely harmed. Indeed, that pink - collar work is a more serious harm to women than rape. My purpose is to urge politically active feminists and feminist organizations to arrange their priorities accordingly and devote most of their resources to working for the elimination of sex segregation in employment.

I hope you will agree, however, that the purpose of the museum should ultimately be to teach the difference between pencils and works of art. What I have called the shrine was set up and visited by people who thought that they knew this difference. You approached the exhibits with an almost religious awe, an awe which certainly was sometimes misplaced but which secured concentration. Our egalitarian age wants to take the awe out of the museum. It should be a (...) friendly place, welcoming to everyone. Of course it should be. Nobody should feel afraid to enter it or for that matter be kept away by his inability to pay. But as far as I can see the real psychological problem here is how to lift the burden of fear, which is the fear of the outsider who feels he does not belong, without also killing what for want of a better word I must still call respect. Such respect seems to me inseparable from the thrill of genuine admiration which belongs to our enjoyment of art. This admiration is a precious heritage which is in danger of being killed with kindness. E. H. Gombrich was director of the Warburg Institute and Professor of the History of the Classical Tradition at the University of London from 1959 to 1976. His books include The Story of Art, Art and Illusion, Meditations on a Hobby Horse, Norm and Form, Symbolic Images, The Heritage of Apelles, and In Search of Cultural History. He became a Fellow of the British Academy in 1960, a Commander of the British Empire in 1966, and was knighted in 1972. He is also a trustee of the British Museum and a foreign member of the American Academy of Arts and Sciences and of the American Philosophical Society. His contributions to Critical Inquiry include "Notes and Exchanges", "Standards of Truth: The Arrested Image and the Moving Eye", and, with Quentin Bell, "Canons and Values in the Visual Arts: A Correspondence". (shrink)

Women in the labor force are at a disadvantage not only because of continuing discrimination in hiring and promotion, but because of factors extrinsic to the labor market hence adjusting conditions within the labor market will not completely eliminate women's disadvantage. Because, unlike most men, most women do not have spouses to take on the major responsibility of running their homes and caring for their children, the costs of working outside the home, particularly in a professional or managerial capacity, are (...) greater for women than they are for men. Thus, even if ongoing discrimination in the labor market were eliminated, through affirmative action policies or other such remedies, women would still be as a disadvantage relative to men.For women, the costs and benefits of behaving like men are different than they are for their male counterparts. To the extent that the costs and benefits of various policies of action are not the same for women as they are for men, men and women are not equal, therefore, arguably, it is not fair to treat them equally. (shrink)

A recent paper in this journal (1) suggests that involving terminally ill patients in choices concerned with Cardio-Pulmonary Resuscitation (CPR) produces 'psychological pain' and therefore is ill-advised. Such a claim rests on anecdotal observations made by the authors. In this paper I suggest that drawing conclusions in ethics, no less than in science, requires a rigorous framework and cannot be relegated to personal observation of a few cases. The paper concludes by suggesting that patients, if we acknowledge their valid interest (...) in making their own choices, must themselves be allowed to make a prior choice about choosing. Those who may not wish to choose may properly be relieved of this burden and may allow another to choose for them. Routinely allowing others to make choices for competent adults, however, is likely to decrease communication with the dying patient and to introduce an atmosphere of suspicion and fear and to exclude the competent patient from his/her rightful place in the community. (shrink)

E. H. Gombrich’s bestselling history of the world for young readers tells the story of mankind from the Stone Age to the atomic bomb, focusing not on small detail but on the sweep of human experience, the extent of human achievement, and the depth of its frailty. The product of a generous and humane sensibility, this timeless account makes intelligible the full span of human history. In forty concise chapters, Gombrich tells the story of man from the stone age to (...) the atomic bomb. In between emerges a colorful picture of wars and conquests, grand works of art, and the spread and limitations of science. This is a text dominated not by dates and facts, but by the sweep of mankind’s experience across the centuries, a guide to humanity’s achievements and an acute witness to its frailties. (shrink)

An accessible selection of Professor Gombrich's best and most characteristic writing.