Both articles in the November‐December 2021 issue of the Hastings Center Report reflect bioethics’ growing interest in questions of justice, or more generally, questions of how collective interests constrain individual interests. Hugh Desmond argues that human enhancement should be reconsidered in light of developments in the field of human evolution. Contemporary understandings in this area lead, he argues, to a new way of thinking about the ethics of enhancement—an approach that replaces personal autonomy with group benefit as the primary criterion (...) for deciding what enhancements are acceptable. In the second article, Johannes Kniess considers the many attempts within bioethics to draw on John Rawls's work to discuss health care access and social determinants of health, and he comes across as moderately optimistic that Rawls's theory of justice has ongoing relevance. (shrink)

There is widespread agreement that medical care offered at the end of a life ought to accord with the preferences of the person whose life it is, at least if the care requested would not be futile. There is considerable evidence, too, that making care more “patient‐centered” in this way would tend to lower the cost of care, for the simple reason that people in those straits often prefer to avoid the most intrusive and therefore most expensive care. So patient‐centered (...) care could be a win‐win of sorts: there could be a collective benefit of lowering costs along with the individual benefit of conforming care better to what the patient wants. But to what degree should the collective benefit be an express goal of health reform, in light of the fact that a given patient might want whatever intrusive, aggressive interventions stand a chance of prolonging life? This question animates several items in this issue of the Report. (shrink)

Generative artificial intelligence (AI) has the potential to transform many aspects of scholarly publishing. Authors, peer reviewers, and editors might use AI in a variety of ways, and those uses might augment their existing work or might instead be intended to replace it. We are editors of bioethics and humanities journals who have been contemplating the implications of this ongoing transformation. We believe that generative AI may pose a threat to the goals that animate our work but could also be (...) valuable for achieving those goals. In the interests of fostering a wider conversation about how generative AI may be used, we have developed a preliminary set of recommendations for its use in scholarly publishing. We hope that the recommendations and rationales set out here will help the scholarly community navigate toward a deeper understanding of the strengths, limits, and challenges of AI for responsible scholarly work. (shrink)

Should there be limits to the human alteration of the natural world? Through a study of debates about the environment, agricultural biotechnology, synthetic biology, and human enhancement, Gregory E. Kaebnick argues that such moral concerns about nature can be legitimate but are also complex, contestable, and politically limited.

This essay summarizes key insights across the essays in the Hastings Center Report's special report “Time to Rebuild: Essays on Trust in Health Care and Science.” These insights concern trust and trustworthiness as distinct concepts, competence as a necessary but not sufficient input to trust, trust as a reciprocal good, trust as an interpersonal as well as structural phenomena, the ethical impermissibility of seeking to win trust without being trustworthy, building and borrowing trust as distinct strategies, and challenges to trustworthiness (...) posed by the contingent nature of science. Together, these insights stand to advance an area of research that we believe has been historically stymied by conceptual confusion and a long‐standing insistence on treating trust as a purely instrumental good. (shrink)

The emerging phenomenon of genetic paternity testing shows how good science and useful social reform can run off the rails. Genetic paternity testing enables us to sort out, in a transparent and decisive way, the age-old but traditionally never-quite-answerable question of whether a child is genetically related to the husband of the child's mother. Given the impossibility of settling this question for certain, British and American law has long held that a biological relationship must almost always be assumed to exist. (...) According to what is known as the “marital presumption” or “presumption of legitimacy,” a child born to a woman within a marital relationship is assumed to be the biological child of the woman's husband unless he was absent, impotent, or sterile. In other words, if paternity was not a physical impossibility for the husband, there was a nearly irrebuttable presumption that he was the father of the child. The husband was locked into the role of fatherhood. a. (shrink)

Bioethicists have sometimes regarded the opioid epidemic as a problem with obvious answers and thus no need for the field's conceptual analysis. Yet, as three essays in the July‐August 2020 issue of the Hastings Center Report demonstrate, the opioid crisis contains a knot of distinctions and puzzles to be sorted out. Travis N. Rieder examines, for example, what is fundamentally driving the crisis—access to the drugs or large societal problems such as poverty and joblessness. The role of choice in addiction, (...) the effects of moral condemnation on approaches to addiction, and what treatment should look like are among the puzzles Hanna Pickard explores, while Daniel S. Goldberg focuses on the common and harmful conflation of the public health problems of substance misuse and pain. These philosophical and bioethical questions point in widely different directions, lying both inside and outside bioethics. They point toward systemic societal factors that determine health and well‐being yet have seemed outside bioethics' largely clinical boundaries. And they point toward a deeper look at the very idea of autonomy—an examination of a topic clearly within bioethics yet occurring at the fringes of its usual constructs. (shrink)

A range of views on the morality of synthetic biology and its place in public policy and political discourse.

The lead article in this January‐February 2021 issue—the first of the Hastings Center Report's fiftieth year of publication—does not set out to change medicine. It tries instead to understand it. In “A Heart without Life: Artificial Organs and the Lived Body,” Mary Jean Walker draws on work in phenomenology and on empirical research with people who have received artificial heart devices to argue that such devices may have two very different effects on how a patient experiences the body and the (...) self. Several other pieces in this issue address the ongoing slew of patient care and health policy problems surrounding the Covid‐19 pandemic, and a special report titled Democracy in Crisis: Civic Learning and the Reconstruction of Common Purpose considers the requirements for public involvement in policy‐making about bioethical issues. (shrink)

How strong is the argument for requiring public deliberation by very large publics—at national or even global levels—before moving forward with efforts to use gene editing on wild populations of plants or animals? Should there be a general moratorium on any such efforts until such broad public deliberation has been successfully carried out? This article works toward recommendations about the need for and general framing of broad public deliberation. It finds that broad public deliberation is highly desirable but not flatly (...) necessary before moving forward with any local cases of gene editing in the wild. It also finds that broad public deliberation would be most helpful in generating very general guidance and is unlikely to be appropriate for specific cases. Broad public deliberation is most helpful for cases that involve higher levels of uncertainty and moral ambiguity, but separating out a distinct class of cases for deliberation is not yet possible. (shrink)

The March–April issue of the Hastings Center Report offers another in a series of articles over the last few years on the structure and the ethics of surrogate decision‐making. Here, Daniel Brudney addresses how to help the surrogate deal with a treatment decision. A core insight he offers is that the structure of the surrogate’s decision has been misunderstood and the misunderstanding makes the task yet harder. As usually understood, the surrogate is supposed to be guided by the question, what (...) would the patient choose, if the patient were making the choice herself? Brudney argues that this conception is impossible, and that the surrogate’s task is instead to consider the patient’s best interests, as illuminated in part by the patient’s expressed values and past choices. This understanding leads, he argues, to a different guiding question: what could the patient choose, given her values? (shrink)

One of the themes running through this issue of the Hastings Center Report is the complexity of how private moral commitments cash out in the public sphere. It's a theme I find both fascinating and important.The lead article is about how hospices in Oregon have dealt with the state's law permitting physician-assisted death. Most patients who have sought physician-assisted death in Oregon did so while in hospice, suggesting to some people that hospices are centrally involved in physician-assisted death—both in patients' (...) decision-making and in administering the medications. In fact, their involvement is much more limited and circumspect, as authors Courtney Campbell and Jessica Cox document.The focus of the article .. (shrink)

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)

In the lead article in the May‐June 2019 issue of the Hastings Center Report, Aaron Wightman and coauthors consider the guiding principles for making decisions about life‐sustaining treatment for children who have profound cognitive impairments. They argue that the usual standard, which asks decision‐makers to consider what will be in the child's best interests, cannot provide sufficient guidance. Discussing this problem in HCR thirty‐five years ago, the philosopher John Arras proposed addressing it by means of a “relational potential standard,” according (...) to which decisions about providing life‐sustaining treatment to a child should depend in part on whether the child has the capacity to form human relationships. Wightman et al. build on Arras's work, but where Arras had suggested that the capacity to form relationships could be gauged by examining the child's cognitive capabilities, the authors suggest that the medical team should lean heavily on the parents’ views. (shrink)

As described by Lori Gruen in the Perspective column at the back of this issue, federally supported biomedical research conducted on chimpanzees has now come to an end in the United States, although the wind-down has taken longer than expected. The process began with a 2011 Institute of Medicine report that set up several stringent criteria that sharply limited biomedical research. The National Institutes of Health accepted the recommendations and formed a committee to determine how best to implement them. The (...) immediate question raised by this transition was whether the IOM restrictions should be extended in some form to other nonhuman primates—and beyond them to other kinds of animals. In the lead article in this issue, Anne Barnhill, Steven Joffe, and Franklin Miller consider the status of other nonhuman primates. (shrink)

Two articles in the September–October 2022 issue of the Hastings Center Report discuss health‐related reasons that people might have to actively bring their lives to an end. In one, Brent Kious considers the situation of a person who, because of illness, becomes a burden on loved ones. A person in such a situation might prefer to die, and Kious argues that, while there is no obligation to hasten one's death, the choice to do so could sometimes be reasonable. In a (...) second article, Henri Wijsbek and Thomas Nys discuss a case in the Netherlands in which a woman with severe dementia was euthanized at a point when her advance euthanasia directive did not align with what she said, when asked, about death. Wijsbek and Nys defend the authority of her advance directive against a range of objections.In a third article, Henry Silverman and Patrick Odonkor, physicians at the University of Maryland Medical Center, where the first pig‐to‐human heart transplantation was performed in early 2022, develop recommendations for clinical trials of porcine heart transplantation. And an essay in the issue criticizes the allocation recommendations developed for Covid‐19 vaccines by the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. (shrink)

In the current issue of The New Atlantis, Daniel Sarewitz, professor of science and society at Arizona State University, argues that science is broken because it is managed and judged by scientists themselves, operating under Vannevar Bush's famous 1945 declaration that scientific progress depends on the “free play of free intellects … dictated by their curiosity.” With that scientific agenda, society ends up with a lot of unnecessary, uncoordinated, and unproductive research. To save science, holds Sarewitz, we need to put (...) it in the hands of people who are looking for practical solutions to specific problems. In one article in this issue of the Hastings Center Report, Kirstin Borgerson poses a question in this same conceptual space: are there too many clinical trials? Other pieces in the issue cover a mix of topics: the lead article addresses some of the challenges that will have to be faced as “artificial organs” become available, a third article looks at how crowdfunding sites like GoFundMe can be used to make public appeals for medical funding, and a special report found in a supplement to the issue offers a round of analysis and recommendations about the provision of medical care to professional football players. (shrink)

The lead article in this issue of the Report proposes an innovative explanation for why the subjects of medical research often seem to have great difficulty accurately gauging whether the research will be medically beneficial for them. The first commentary lauds the paper and examines its implications in greater detail; the second lauds the effort to rethink subjects' capacities for assessing the therapeutic benefit of research but raises questions about the paper's conceptual framework. The article is about how subjects think (...) about the research they're in. The nature of thought is also the subject of the special report, published as a supplement to the issue, on the uses of stories in bioethics. Essays contributed by some of the scholars who have been prominent in narrative ethics try to articulate why and how thinking in terms of stories can be valuable in the midst of a clinical bioethics consultation.. (shrink)

This issue of the Report is bookended by two pieces that take contrasting although perhaps compatible positions on medical care for those in dire straits. At the end of the issue is an article that considers whether patients may be denied admission to intensive care units on grounds that they are too sick to benefit. We think of ICUs as reserved for the sickest of the sick, notes author Andrew Courtwright, but in fact, “too sick to benefit” is an increasingly (...) common reason given for not putting a patient in the ICU. Meanwhile, the first essay in the book tells the story of a man whose physician more or less told him he was too sick to benefit (under some understanding of the idea) and should opt for death. (shrink)

In a 2015 Hastings Center Report essay, Robert Truog and his coauthors argued that the clinical ethics portion of medical education should cast both a wider and a finer net than is sometimes realized. Many of the morally important moments in patient care are missed if we teach only general moral principles, they held; we also need to give attention to an indefinite stream of “microethical” decisions in everyday clinical practice. In the current issue, Truog plays out a similar theme (...) as he discusses the moral significance of touching a patient and asks how artificial intelligence and other emerging technologies may change this ancient part of the physician‐patient relationship. And one of the articles in this issue examines the significance of clinicians’ relationships with other clinicians. Donna Chen and colleagues propose, in effect, that “teamwork” has become part of the ethics of everyday clinical practice—a new addition to what Larry Churchill and David Schenck called the “healing skills.”. (shrink)

The emergence of de‐extinction is a study in technological optimism. What has already been accomplished in recovering ancient genomes, recreating them, and reproducing animals with engineered genomes is amazing but also has a long ways to go to achieve “de‐extinction” as most people would understand that term. Still, with some caveats in place, creating a functional replacement for an extinct species may sometimes be doable, and given the right goals, might sometimes make sense. The International Union for Conservation of Nature (...) guidelines for de‐extinction do a reasonable job of keeping the caveats in place and clarifying the goals. In fact, given the right caveats about what de‐extinction can accomplish, we should pay a lot of attention to the technology and should think carefully about the goals. Not only has the technology been advancing, but our environmental standards have been getting looser and more flexible, providing less guidance for implementing the technology. The guiding ideals for conservation are often explained as a choice between John Muir, founder of The Sierra Club, and Gifford Pinchot, who helped create the U.S. Forest Service. Muir argued for preserving some places in the world in their natural state because of their great value and beauty. Pinchot, by contrast, was bluntly utilitarian. He argued for trying to keep some natural places more or less undamaged so that we could use them later. There has long been dissatisfaction with this choice, and in the last couple of decades, a number of prominent voices have proposed a “gardening ethic” as a new standard that combines elements of Muir and Pinchot. A gardening ethic is supposed to both celebrate the land and declare that it must now be managed. But what would good gardening mean when it comes to de‐extinction? (shrink)

The release of genetically engineered organisms into the shared environment raises scientific, ethical, and societal issues. Using some form of democratic deliberation to provide the public with a voice on the policies that govern these technologies is important, but there has not been enough attention to how we should connect public deliberation to the existing regulatory process. Drawing on lessons from previous public deliberative efforts by U.S. federal agencies, we identify several practical issues that will need to be addressed if (...) relevant federal agencies are to undertake public deliberative activities to inform decision‐making about gene editing in the wild. We argue that, while agencies may have institutional capacity to undertake public deliberative activities, there may not be sufficient political support for them to do so. Advocates of public deliberation need to make a stronger case to Congress about why federal agencies should be encouraged and supported to conduct public deliberations. (shrink)

: A comparison of casuistry with the strain of particularism developed by John McDowell and David Wiggins suggests that casuistry is susceptible to two very different mistakes. First, as sometimes developed, casuistry tends toward an implausible rigidity and systematization of moral knowledge. Particularism offers a corrective to this error. Second, however, casuistry tends sometimes to present moral knowledge as insufficiently systematized: It often appears to hold that moral deliberation is merely a kind of perception. Such a perceptual model of deliberation (...) cannot offer a convincing account of the possibility of moral progress. This second problem is one to which particularism is itself prone. To redress it, other aspects of casuistry must be exploited: Casuistry contains an account of presumptive generalizations that explains how moral deliberation might be structured by rules while also depending at critical junctures on perception. (shrink)

This issue of the Hastings Center Report features a couple of interesting takes on the governance challenges of emerging technologies. In an essay on the National Academies of Science, Engineering, and Medicine report published this February on human germ-line gene editing, Eric Juengst, a philosopher at the University of North Carolina, argues that the NASEM committee did not manage to rethink the rules. Juengst reaches what he calls an “eccentric conclusion”: “The committee's 2017 consensus report has been widely interpreted as (...) ‘opening the door’ to inheritable human genetic modification and holding a line against enhancement interventions. But on a close reading it does neither.” In the column Policy and Politics, Sarah Chan, a chancellor's fellow at the University of Edinburgh, discusses the emerging science of “organoids,” “embryoids,” and “synthetic human entities with embryo-like features” and calls for a sustained effort to rethink the rules for embryo research. (shrink)

Advancing neuroscience is one of many topics that pose a challenge often called “the alignment problem”—the challenge, that is, of assuring that science policy is responsive to and in some sense squares with the public's values. This issue of the Hastings Center Report launches a series of scholarly essays and articles on the ethical and social issues raised by this vast body of medical research and bench science. The series, which will run under the banner “Neuroscience and Society,” is supported (...) by the Dana Foundation and seeks to promote deliberative public engagement, broadly understood, about neuroscience. As a social goal, deliberative public engagement is both ubiquitous and elusive—called for everywhere yet difficult to undertake at a national level on a complex scientific topic. To be meaningful, deliberative public engagement must occur in many locations in a society and be carried forward by many actors. Scholarly writing might contribute in several ways. (shrink)

Can we make wise policy decisions about still‐emerging technologies—decisions that are grounded in facts yet anticipate unknowns and promote the public's preferences and values? There is a widespread feeling that we should try. There also seems to be widespread agreement that the central element in wise decisions is the assessment of benefits and costs, understood as a process that consists, at least in part, in measuring, tallying, and comparing how different outcomes would affect the public interest. But how benefits and (...) costs are best weighed when making decisions about whether to move forward with an emerging technology is not clear. Many commentators feel that the weighing is often inadequate or inappropriate. Those who argue for a “precautionary” approach to the weighing do so precisely because they feel the need for a restraint on the dominant decision‐making tools and processes for assessing outcomes.This Hastings Center special report examines those tools and processes, taking the method known as cost‐benefit analysis as a starting point. In U.S. governance, CBA, sometimes informed by risk assessment, is the most widely used and extensively studied method, and authoritative reports on genetic and reproductive technologies often use language suggestive of cost‐benefit analysis. There is also a long‐running debate about the role of values in CBA and other formal impact assessment mechanisms—and about how those mechanisms compare to the precautionary principle. The guiding idea in the report is to engage in a close examination of the strengths and limits of CBA for ensuring that emerging technologies are used in ways that square with the public's values, drawing on applications of synthetic biology to illustrate and sharpen the analysis and then considering corrections to CBA and some alternative methodologies that handle values differently. (shrink)

The two articles in this issue of the Report consider different ways that hospitals' organizational failings can be masked by ethics talk. In the lead article, Ann Hamric, John Arras, and Margaret Mohrmann take a critical look at the increasingly popular view that courage is a vital part of the moral armamentarium of health care professionals. It's easy to overemphasize and distort this point, they argue. Alexandra Junewicz and Stuart Youngner have a somewhat similar take on patient satisfaction surveys, which (...) are now in widespread use at most hospitals. Surveys are valuable, say Junewicz and Younger, but it is very easy to make too much of them and to misuse them. (shrink)

When a set of articles or essays in the Report revolves around some common theme, we have planned it that way only about half the time. With this issue, I realized halfway through its assembly that we would have two pieces on what one of the articles calls “the woman question.” Quite late in production, I realized that these two pieces were themselves part of a broader theme: several of the columns also address the health care of people who are (...) socially marginalized in one way or another. (shrink)

One of the foundational thoughts in bioethics is that professional roles can generate special ethical obligations. Bioethics first emerged as an effort to understand the special ethical obligations of physicians and researchers. But bioethics now finds itself subject to a converse thought. Bioethicists engaged in clinical ethics consultations‐discussing patient care and decision‐making with physicians and others‐have a special ethical obligation toward patients and coworkers, and that obligation has generated a professional role, as it were. Clinical ethicists bear the obligation of (...) ensuring that ethical standards for patient care are upheld, and since this work requires special skills and knowledge, clinical ethicists can be asked to demonstrate that they have what it takes and can bring it effectively to bear in consultations. The evolution of clinical ethical consultation is the topic of the lead article in this issue of the Report. The second article in this issue returns to that ur‐topic‐the ethical obligations of physicians and researchers. (shrink)

For the last couple of years, The Hastings Center has been running a research project titled “The Ethical Issues of Synthetic Biology” (funded by the Alfred P. Sloan Foundation) that is focused primarily on whether the prospect of altering microorganisms to meet human ends is intrinsically troubling. “Synthetic biology” is not necessarily limited to the alteration of microorganisms, but the applications now under development—such as yeast that produce a precursor of the antimalarial drug artemisinin or blue-green algae that produce fuel—are (...) certainly limited to that. A set of essays in this issue of the Report features a variety of different takes on the field. For the last six months of the project .. (shrink)

This issue of the Hastings Center Report includes a special report that comes out of a three-year Hastings Center research project on controversies surrounding the diagnosis and treatment of mental disorders in children. Over the last couple of decades, the number of children diagnosed with mental disorders has risen significantly, and so, too, has the number of children prescribed medications. Some critics have accused psychiatry of overdiagnosis—of sometimes diagnosing children with psychiatric disorders when their behavior is actually within the range (...) of normal. This controversy led Erik Parens and Josie Johnston, authors of the report and the Hastings Center investigators in this project, to ask what a .. (shrink)

The Affordable Care Act survived the Supreme Court—but “just barely”—according to Mark Hall, a contributor to the Report's At Law column. That “just barely” leaves much to ponder, and in this issue a special installment of At Law, appearing as a set of essays, looks into it.

This essay introduces a special report from The Hastings Center entitled Democracy in Crisis: Civic Learning and the Reconstruction of Common Purpose, which grew out of a project supported by the John S. and James L. Knight Foundation. This multiauthored report offers wide‐ranging assessments of increasing polarization and partisanship in American government and politics, and it proposes constructive responses to this in the provision of objective information, institutional reforms in government and the electoral system, and a reexamination of cultural and (...) political values needed if democracy is to function well in a pluralistic and diverse society. The essays in the special report explore the norms of civic learning and institutions, social movements, and communal innovations that can revitalize civic learning in practice. This introductory essay defines and explains the notion of civic learning, which is a lynchpin connecting many of the essays in the report. Civic learning pertains to the ways in which citizens learn about collective social problems and make decisions about them that reflect the duties and responsibilities of citizenship. Such learning can occur in many social settings in everyday life, and it can also be facilitated through participation in the processes of democratic governance on many levels. Civic learning is not doctrinaire and is compatible with a range of public goals and policies. It is an activity that increases what might be called the democratic capability of a people. (shrink)

The lead article in the Hastings Center Report's November‐December 2020 issue reconsiders the rationale for requiring that patients have a prescription from a physician to obtain a drug. Madison Kilbride, Steve Joffe, and Holly Fernandez Lynch conclude that growing respect for patient autonomy should lead to a new default for drug access: drugs should be available over the counter unless there are special concerns about harms to third parties or about patients' ability to make decisions for themselves. This conclusion would (...) be a substantial reorientation of drug policy in the United States. Bioethics at a societal level is a theme in the second article, “The Social Risks of Science,” and throughout the issue. (shrink)

Two articles in the March‐April 2021 issue of the Hastings Center Report consider alterations to traditional informed consent. In “The Consent Continuum: A New Model of Consent, Assent, and Nondissent for Primary Care,” Marc Tunzi and colleagues argue that, in primary care settings, patient consent should be understood as taking a range of forms depending on the procedure, the patient, and the patient‐care context. Traditional informed consent is at the ceremonious end; for many things done in these settings, the authors (...) assert, assent or even nondissent is fine. In the lead article, health policy scholars Stephanie Morain and Emily Largent consider another continuum for informed consent, this one occurring with pragmatic research, at the intersection of clinical care with research. (shrink)

This issue of the Hastings Center Report features three articles exploring aspects of decision-making for others. In the first two, the focus is on the limits of surrogate decision-makers’ authority when the surrogates’ judgments about a patient's treatment conflict with the physicians’. If a physician decides that a patient will not benefit from CPR, for example, but the patient's surrogate insists on it, is the physician obliged to proceed with the procedure? Or can the physician, pointing to a duty to (...) provide good care to the patient and not to cause the patient to suffer, get a do-not-resuscitate order for the patient—even in the face of the surrogate's objections? These are the questions that animate the first article, in which a group of authors report on a policy implemented at Massachusetts General Hospital to help doctors who face this dilemma. The second article, by physician Jeffrey Berger, flips the questions. If a physician decides that a patient's intractable suffering requires palliative sedation, may the surrogate prevent it anyway? Or can the physician, pointing to a duty to alleviate the suffering, administer palliative sedation even in the face of the surrogate's objections? Such circumstances, says Berger, show the need for conceptual work delineating the limits of surrogates’ authority and practical work on mechanisms for doing so—protecting patients and giving physicians a clear route to follow. (shrink)

I want caregivers who are solid, well-rounded, well-grounded people and who relate well to other people. That probably means they have a pretty good sense of humor. I would also expect any doctor with a sense of humor sometimes to find humor in some of the more difficult aspects of patient care, and even to make jokes about very serious things—about tragedies, poor prognoses, deaths. Humor can also be put to good use in human interactions—it’s not just something I’d expect (...) to see in normal, healthy human interactions; it can be an exceptionally powerful tool for moving a conversation forward, and for bringing people in the conversation together. But of course, it has to be used properly. I don’t want my doctor to .. (shrink)

The lead article in this issue of the Hastings Center Report explores the ideas underpinning the Precision Medicine Initiative, the effort announced by President Obama in 2015 to promote the development of treatments adjusted to genetic and other variations. Authors Maya Sabatello and Paul Appelbaum hold that the effort works by appealing to a sense of collective identity and shared commitment—an understanding that they call the “PMI nation.” But what are the moral implications of this idea? Sabatello and Appelbaum's question (...) about the impact of an imagined community is an unusual way of exploring a set of values questions. In the second article, Johann Brännmark defends what is, at least in bioethics, an unusual philosophical framework for moral values. Brännmark starts by calling attention to large, never-quite-solved problems with the field's going way of understanding personhood and autonomy, and then argues that the body of tradition, law, and international governance known as the human-rights framework offers a solution to those problems. And a supplement to this issue offers a set of essays on a topic outside the usual range for bioethics: the prospect of “de-extinction”—that is, of using genetic and reproductive technologies to construct simulacra of extinct animals that might eventually be introduced into the wild. (shrink)

The Covid‐19 pandemic has highlighted connections between health and social structural phenomena that have long been recognized in bioethics but have never really been front and center—not just access to health care, but fundamental conditions of living that affect public health, from income inequality to political and environmental conditions. In March, as the pandemic spread globally, the field's traditional focus on health care and health policy, medical research, and biotechnology no longer seemed enough. The adequacy of bioethics seemed even less (...) certain after the killing of George Floyd, whose homicide showed in an especially agonizing way how social institutions are in effect (and often intentionally) designed to make the lives of black people go poorly and end early. Whether bioethics needs to be expanded, redirected, and even reconceived is at the heart of the May‐June 2020 issue of the Hastings Center Report, which is devoted to questions provoked by and lessons emerging during this pandemic. (shrink)

The January‐February issue of the Report introduced a number of new features designed to provide opportunities for further give‐and‐take in our pages. In this issue, we put to use our revamped letters to the editor, Exchange, with a set of commentaries on another of the January‐February articles, Daniel Callahan's “Obesity: Chasing an Elusive Epidemic.” Commentaries in Other Voices and special reports are planned and solicited, in consultation with scholars in the field and with the guest editors of the special reports, (...) but our hope is that Exchange will provide an opportunity for unsolicited voices in the Report. Of course, Callahan's controversial article is all too good for drumming up unsolicited commentary: Callahan argued that the rise in obesity requires an aggressive public health campaign that employs some stigmatization of obesity. (shrink)

Two articles in this issue of the Hastings Center Report push the boundaries of bioethics, but in radically different directions. The lead article offers a new understanding of clinical translation—the process, that is, of generating clinical tools from the theoretical understanding of disease developed in the laboratory. The topic is important because, as Kimmelman and London point out, clinical translation is widely held to be in trouble. In general, the feeling is that there's been lots of basic science on disease (...) mechanisms over the last twenty years or so, but there's only a trickle of good new medications in the “drug pipeline.” Kimmelman and London's claim, crudely put, is that we’re looking at it wrong.In a second article, John Hardwig, author of one of the Report's more frequently mentioned articles, “Is There a Duty to Die?,” continues in somewhat that same surprising and maybe even contrarian vein by asking, in effect, whether there can ever be a duty to have an abortion. (shrink)

This issue marks the beginning of a new publishing venture for The Hastings Center. After forty‐plus years of publishing the Hastings Center Report independently, the Center has decided to collaborate with Wiley‐Blackwell to get the Report out into the world. Hastings retains ownership and full editorial and artistic control; we will put the Report together just as we have always done. But for all of the things that I think of as going under the heading of publishing services—primarily printing, online (...) hosting, mailing, and subscription services—we will now collaborate with Wiley‐Blackwell. The relationship will broaden the Report's reach and improve its services, but will not change the Report's appearance or content. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Real-life BioethicsGregory E. KaebnickMy academic training is in philosophy, and I tend to see the problems in bioethics as philosophical problems. And so they often are. What are moral values? What is the nature of rationality? These are certainly philosophical problems. But at the same time, they are not strictly philosophical problems, insofar as they are not the special purview of the field of philosophy. They require a broader (...) treatment, and that broader treatment might even lead us to believe that the standard philosophical treatment is unsatisfactory.In one way or another, several items in this issue of the Hastings Center Report raise questions about the standard philosophical answers to issues in bioethics. The challenge is most explicit in Barry Hoffmaster’s article, “The Rationality and Morality of Dying Children.” Hoffmaster launches a frontal assault on the typical philosophical understanding of ethics, applied ethics, and bioethics. “There is more rationality in our lives than there is in our philosophy,” he begins. The usual take in philosophy on rationality “hides the real nature and extent of the rationality and the morality in our lives because it denigrates, if not ignores, our experience and our creativity.” Closer attention to our experience is therefore needed, and Hoffmaster tries to take a step in that direction by considering anthropological research on how children dying of leukemia learned about their condition and then dealt with that knowledge.The lead article, by Tony Hope and three coauthors, questions standard philosophical approaches to decision-making in a different way. Hope and his colleagues consider whether the concept of authenticity is useful for exploring how patients with anorexia nervosa understand their condition and deal with that knowledge. Further, they ask, if the concept is important for people with anorexia, should it be important for clinicians, who sometimes need to make decisions on behalf of those women? Arguably, they explain, “in respecting autonomy, it is the authentic wishes that should be respected. This would be to give the idea of authenticity a role analogous to that of capacity (competence).”Hope and colleagues are skeptical that “authenticity” can help others make decisions on behalf of women with anorexia nervosa. There is no good way of deciding which decisions would count as “authentic.” But thinking about how to make decisions is not the full extent of bioethics. As the essay by Rebecca Dresser emphasizes, attempting to understand the patient’s experience of illness is another and important part of bioethics, even though bioethicists themselves do not always see it that way. “At times,” writes Dresser, “work in our field conveys the impression that seriously ill patients and their families would be in good shape if clinicians would only do things like give patients the proper information, respect patients’ choices, and follow advance directives.” Just as Hope and colleagues argued for attending more closely to the concept of authenticity, Dresser argues for attending to concepts like dignity, mortality, and grief. These concepts “may be difficult to incorporate into bioethical analysis, but they are the sorts of concerns that matter to people dealing with serious illness.”A bioethics that dealt better with them would still be a philosophical bioethics, but certainly not just a bioethics of philosophy. It would be what Dresser calls a “real-life bioethics.” —GEK [End Page 2]Copyright © 2011 The Hastings Center... (shrink)

In some sense, argues Christopher Meyers in the lead article in this, the July‐August 2021, issue of the Hastings Center Report, to be a good ethicist is to be an activist. The question for the ethicist, and for Meyers, is about how hard and far to push: how much personal risk to shoulder, how much to tick off colleagues, how much institutional disruption to create, how much to look like an angry protester. Meyers argues for aiming at the middle, in (...) two senses. In a time of anger and activism about relentless, pervasive, overwhelming wrongs, the question of balance is increasingly front of mind. A set of commentaries we solicited both welcome Meyers's call for activism and push for more. (shrink)