Bioethics needs an expanded moral vision. It is now time for bioethics to take full account of the problems of health disparities and structural injustice that are made newly urgent by the COVID-19 pandemic and the effects of climate change. Nancy M. P. King, Gail E. Henderson, and Larry R. Churchill make the case for a more social understanding and application of justice, a deeper humility in assessing expertise in bioethics consulting, a broader and more relevant research agenda, and (...) greater appreciation of the profound health implications of global warming. (shrink)

Why mediation? -- What makes bioethics mediation unique? -- Before you begin a bioethics mediation program -- The stages of bioethics mediation -- Techniques for mediating bioethics disputes -- How to write a bioethics mediation chart note -- Mediation with a competent patient : Mr. Samuels's case -- Mediation with a dysfunctional family : Mrs. Bates's case -- A complex mediation with a large and involved family : Mrs. Leonari's case -- Discharge planning for a dying patient : a role-play (...) -- An at-risk pregnancy : a role-play -- HIV and postsurgical complications in the ICU : a role-play -- Treating the dying adolescent : a role-play -- She didn't mean it : a role-play -- Don't tell mama : a role-play -- An at-risk pregnancy : a role-play transcript -- HIV and postsurgical complications in the ICU : a role-play transcript -- She didn't mean it: a role-play transcript -- Don't tell mama : a role-play transcript. (shrink)

Public health ethics in the future will be distinguished from public health ethics in the past by this new subfield being labeled as such, acknowledged, and called upon for service. Ethical dilemmas have been present throughout the history of public health. The question of whether to force Henning Jacobson to be immunized in 1905 in accordance with the 1902 Massachusetts smallpox vaccination law was one of ethics as well as law. How Thomas Parran, Surgeon General in 1936, chose to respond (...) to a raging syphilis epidemic in the United States in the early part of the 2W century raised considerable moral debate in determining the appropriate public health response for a government? More recently, questions have arisen concerning the appropriate reach of government in controlling HIV banning smoking, or promoting healthy lifestyles. Debates over government infringement, morality, and justice recur throughout the history of public health. (shrink)

This paper describes a global pattern of declining academic freedom, often driven by powerful political interference with core functions of academic communities. It argues that countering threats to academic freedom requires doubling down on ethics, specifically standards of justice and fairness in pursuing knowledge and assigning warrant to beliefs. Using the example of the selection of a Qatari university to host the 2024 World Congress of Bioethics, the authors urge fairness towards diverse groups over time and efforts to counter injustices (...) that conferences generate. (shrink)

A study of visual culture in the teaching of the life sciences.

Giving up the increasingly troubled distinction between “experiment” and “treatment” would make it easier to focus on informed consent and harder to beg questions about uncertainty and shared decisionmaking in medicine.

The prospect of rescuing a person in immediate peril seems at first glance to be an unqualified good. Take, for example, the events of April 15, 2013, at the 117th Boston Marathon. Two consecutive...

How one reacts to lying depends on individual temperament, intellectual training and value commitments, freedom status,, consideration of consequences, emotional resilience an...

Research illustrates that social movements can fuel new markets and that these markets can create social change, but the role of leaders in this process is less understood. This exploratory interview-based study of the localism movement contributes to such understanding. It articulates the relationship of social movement leaders and the legitimacy of their organizations to new market creation. Specifically, leaders in this study engaged in a dual role to legitimize their organizations and to legitimize the movement. At an organizational level, (...) leaders chose strategies that conformed to a conventional organizational model of the social movement organization as a business network, much like a local chamber of commerce. At a movement level, the SMO’s level of legitimacy influenced the leader’s choice of strategies to grow a “local” market. These strategies aimed, primarily, to shape consumer purchase behavior and, secondarily, to foster the development of producers’ skills, and only in a tertiary way, to alter the nature of exchange. Finally, this study’s findings suggest a tension between the dual roles that may ultimately challenge the efficacy of the movement. (shrink)

These are the challenges taken up in Obligations of Citizenship and Demands of Faith, an exploration of the place of religion in contemporary public life.

While people are still alive, we owe them respect. Yet what, if anything, do we owe the newly dead? This question is an urgent practical concern for aged societies, because older people die at higher rates than any other age group. One novel way in which Japan, the frontrunner of aged societies, meets its need to accommodate high numbers of newly dead is itai hoteru or corpse hotels. Itai hoteru offer families a way to wait for space in over‐crowded crematoriums (...) while affording an environment conducive to grieving. Drawing on conversations with itai hoteru employees, we delineate the values this contemporary death practice expresses and show how these values comprise part of the broader idea of a good death. A good death implies duties on both sides of death's divide: to both the dying and the newly dead. (shrink)

The paper begins by drawing a distinction between “allocation” — the distribution of resources between different categories, and “rationing” — the distribution of scarce resources within a single category. I argue that the current allocation of funds to health care makes some form of rationing unavoidable. The paper next considers proposals by Daniel Callahan and Norman Daniels supporting age rationing publicly-financed life-extending medical care. I provide reasons for doubting that either argument succeeds. The final section of the paper sets forth (...) an alternative approach which holds that if people have any rights to health care, then they have a right to a decent minimum. (shrink)

Elements of the relation between religion and politics are standard themes in political theory: toleration and free exercise rights; the parameters of separation of church and state; arguments for and against constraints imposed on religious discourse by philosophic norms of public reason. But religious parties and partisanship are no part of political theory, despite contemporary interest in value pluralism and in liberal democratic theory's capacity to address multicultural, religious, and ethnic group claims. This essay argues that religious parties are missing (...) elements in discussions of identity politics. They play an important role not just in expressing but also in constructing and mobilizing religious political identity. Political activity linked to parties is a principal way of bringing diffuse, politically unorganized groups, whose leaders are self-appointed and not regularly accountable for the way they represent co-religionists in political life, into the democratic mainstream. With political organization and especially partisanship, the fact of pluralism is made concrete for democratic purposes. (shrink)

Engages and extends the feminist philosopher Lorraine Code's groundbreaking work on epistemology and ethics.

In “How the Neuroscience of Decision Making Informs Our Conception of Autonomy,” Gidon Felsen and Peter Reiner (2011) argue that decisions typically regarded as rational and autonomous are in fact...

Preston & de Waal minimized differences among constructs such as empathy, sympathy, and personal distress. However, such distinctions have been shown to relate differently to altruistic behavior. Moreover, although the authors discussed the role of regulation in empathy, they did not consider the possibility that sometimes empathy is not well-regulated and likely leads to personal distress rather than sympathy.

For those with advanced life-limiting illness, the optimization of quality of life and avoidance of nonbeneficial treatments at the end of life are key ethical concerns. This article evaluates the efficacy of an Interdisciplinary Ethics Panel (IEP) approach to decision making at the end of life for unbefriended nursing home residents who lack decisional capacity and have advanced life-limiting illness, through the use of a ninestep algorithm developed for this purpose. We reviewed the outcomes of three quality-of-care phased initiatives conducted (...) in our facility, a large public nursing home in New York City, between June 2016 and February 2020, which indicated that this IEP approach promoted advance-care planning, as palliative measures were endorsed to optimize quality of life for this vulnerable population at the end of life. We also examined another quality-of-care initiative when this IEP approach was applied to end-of-life decision making for nursing home residents who had a surrogate during the COVID-19 pandemic. This application appeared to be beneficial in adding more residents to our Palliative Care Program while it improved rates of advance-care planning. When all of the above findings are considered, we believe this novel IEP approach and algorithm have the potential to be applied elsewhere after appropriate assessment. (shrink)

The paper begins by tracing the historical development of American medicine as practice, profession, and industry from the eighteenth century to the present. This historical outline emphasizes shifting conceptions of physicians and physician ethics. It lays the basis for showing, in the second section, how contemporary controversies about the physician’s role in managed care take root in medicine’s past. In the final two sections, I revisit both the historical analysis and its application to contemporary debates. I argue that historical narratives (...) can function as “master narratives” that suppress or leave out historical facts. I bring to the surface what is covered up by the master narrative approach, and show its relevance to contemporary ethical debates. I conclude by proposing that preserving the integrity of medicine will require modifying the master narratives we tell about physicians. The integrity of medicine also offers new perspectives for thinking about managed care and the broader topic of health care reform. (shrink)

Debates about medical futility first emerged in the scholarly literature during the 1990s after empirical studies showed the widespread use of medical interventions offering no reasonable chance of...

Over the next 15 years, the government-funded human genome project will map and sequence each of the human cell’s estimated 100,000 genes. The project’s first fruits will be a vast quantity of information about genetic disease. This information will contribute to the design of quicker, cheaper and more accurate tests for identifying deleterious genes in individuals. Because genetic conditions are often regarded as “immutable, heritable taints that intrinsically implicate the bearer’s identity,” overly-deterministic interpretations of genetic information can readily distort genetic (...) risk and become enshrined in institutional policies of social isolation and discrimination. (shrink)