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“INTELLECTUAL LIGHTENING”: A tribute to John Harris through a collection of memories, imaginary books, fictional reviews, and an interview. John Harris’ impressive and diverse academic career is illustrated and remembered by his colleagues who each contribute with a special memory, story or fake book review, in order to thank John and to cherish the memories. A good philosopher, a kind person, a teacher, different aspects of his work are discussed.
Bioethics education in residency helps trainees achieve many of the Accreditation Council for Graduate Medical Education milestones and gives them resources to respond to bioethical dilemmas. For this purpose, The Providence Center for Health Care Ethics has offered a robust clinical ethics rotation since 2000. The importance of bioethics for residents was highlighted as the COVID-19 pandemic raised significant bioethical concerns and moral distress for residents. This, combined with significant COVID-19-related practical stressors on residents led us to develop a virtual ethics rotation. A virtual rotation allowed residents flexibility as they were called to help respond to the unprecedented demands of a pandemic without compromising high quality education. This virtual rotation prioritized flexibility to support resident wellbeing and ethical analysis of resident experiences. This article describes how this rotation was able to serve residents without overstraining limited bandwidth, and address the loci of resident pandemic distress. As pandemic pressures lessened, The Providence Center for Health Care Ethics transitioned to a hybrid rotation which continues to prioritize resident wellbeing and analysis of ongoing stressors while incorporating in-person elements where they can improve learning. This article provides a description of the rotation in its final form and resident feedback on its effectiveness.
Jennifer Blumenthal-Barby (2024) has called for bioethics to end talk about personhood, asserting that such talk has the tendency to confuse and offend. It will be argued that this has only limited application for (largely) private settings. However, in other settings, theorizing about personhood leaves a gap in which there is the risk that the offending concept will get uptake elsewhere, and so the problem Blumenthal-Barby nominates may not be completely avoided. In response to this risk, an argument is presented in support of the idea that the role of philosophers and bioethicists, far from ending talk of personhood, ought to be to clarify the concept, and to do so in nuanced ways, given its application for specific kinds of impairments. The case of dementia is used to illustrate this in the context of person-centered care. Ironically, given the stigma attached to dementia, far from the need to end talk of personhood, bioethicists are needed to rescue the concept and clarify its role.
In the twentieth century, settler states have operated through science. At the same time, the field of American bioethics has safeguarded the moral authority of science. It has done so by upholding the settler logics of the sciences that it claimed to hold to account. This chapter explores how the imperial logic of American bioethics works – through its concepts, practices, and imperceptions. To do so, the chapter follows Carolyn Matthews, an everyday American with a rich “vernacular archive” and apt work experiences, across three medical sites and over three postwar decades. It tells Carolyn’s story in two registers – setting Carolyn’s work experience prior to 1974, when the US Congress passed laws for the treatment of human subjects, alongside Carolyn’s moral recounting of those work experiences in the late 1970s. Carolyn’s case offers insight into how the vocabulary and framework of modern American bioethics embeds a moral ontology organized around civic individualism and its safeguarding, as opposed to anticolonialism and its dismantling. The aim of this critique of bioethics through the Americas is to strengthen existing alliances for justice-based science and to inform anticolonial practices – in science, history, and transformative bioethics.
The authors critique the NY Declaration on Animal Consciousness, which does not denounce continued captivity and invasive research in the pursuit of animal consciousness markers. They argue that such research often increases animal suffering by accepting harmful practices. Instead, they propose a nonanthropocentric, ethical framework aligned with the Belmont Report’s principle of beneficence, advocating for noninvasive methods in natural habitats. This approach prioritizes animal well-being, recognizing and safeguarding the intrinsic value of all conscious beings.
The Ethics Committee at Memorial Sloan Kettering Cancer Center (MSK) developed a Bioethics Ambassador Program (BAP); a yearlong educational program to assist clinical and non-clinical staff develop the skills to identify and address common burgeoning ethical issues that can arise during the provision of care to patients with cancer. The goal was to provide greater awareness of the role and services of Ethics, particularly at the institution’s geographically-diverse outpatient care centers and to better-instill a culture of preventative ethics. This article discusses the design and implementation of the first two years of the program and analyzes its strengths, weaknesses, and impact on MSK.
There are increasing calls for coverage of medicine during the Holocaust in medical school curricula. This article describes outcomes from a Holocaust and medicine educational program featuring a study trip to Poland, which focused on physician complicity during the Holocaust, as well as moral courage in health professionals who demonstrated various forms of resistance in the ghettos and concentration camps. The trip included tours of key sites in Krakow, Oswiecim, and the Auschwitz-Birkenau concentration camps, as well as meeting with survivors, lectures, reflective writings, and discussions. In-depth interviews and reflective writings were qualitatively analyzed. Resulting themes centered on greater understanding of the relationship between bioethics and the Holocaust, recognizing the need for moral courage and social awareness, deeper appreciation for the historical roles played by dehumanization and medical power and their contemporary manifestations, and the power of presence and experiential learning for bioethics education and professional identity formation. These findings evidence the significant impact of the experience and suggest broader adoption of pedagogies that include place-based and experiential learning coupled with critical reflection can amplify the impact of bioethics and humanism education as well as the process of professional identity formation of medical students.
Germline gene editing (GGE) is a controversial procedure, prohibited by most intergovernmental and scientific bodies and is not currently medically utilized. However, given circumstances where GGE would be essential for human survival, it is possible that GGE could be ideal, ethical and even necessary. One such possible instance of this circumstance could be long-term presence of humans on other planets. In our paper, we point out that there is a strong case for genetically modifying humans, including through GGE, for a future settlement in space directed at preserving human (and other) species. To avoid unnecessarily suffering and death from such difficult missions and environments, GGE enhancements should be considered, although only if shown to be safe, well-regulated and efficacious. We also examine and detail how major ethical frameworks can be shown to support, rather than prohibit, such procedures.
This article argues that beneath the veneer of legitimacy in the organ, tissue, and body part transplantation systems exists a horrifying history of human commodification whose vestiges surprisingly linger in contemporary supply and allocation systems. This history, as the Article demonstrates, dates back to the colonial period in the United States, where “grave robbing” became an important feature in the advancement of medicine. This legacy lives on.
No two people are the same, and no two groups of people are the same. But what kinds of differences are there, and what do they mean? What does our DNA say about race, gender, equality, or ancestry? Drawing on the latest discoveries in anthropology and human genetics, Understanding Human Diversity looks at scientific realities and pseudoscientific myths about the patterns of diversity in our species, challenging common misconceptions about genetics, race, and evolution and their role in shaping human life today. By examining nine counterexamples drawn from popular scientific ideas, that is to say, examinations of what we are not, this book leads the reader to an appreciation of what we are. We are hybrids with often inseparable natural and cultural aspects, formed of natural and cultural histories, and evolved from remote ape and recent human ancestors. This book is a must for anyone curious about human genetics, human evolution, and human diversity.
Public health data available for research are booming with the expansion of Big Data. This reshapes the data sources for DOHaD enquiries while offering ample opportunities to advance epidemiological modelling within the DOHaD framework. However, Big Data also raises a plethora of methodological challenges related to accurately characterising population health trajectories and biological mechanisms, within heterogeneous and dynamic sociodemographic contexts, and a fast-moving technological landscape. In this chapter, we explore the methodological challenges of research into the causal mechanisms of the transgenerational transfer of disease risks that characterise the DOHaD research landscape and consider these challenges in the light of novel technologies within artificial intelligence (AI) and Big Data. Such technologies could push further the collating of multidimensional data, including electronic health records and tissue banks, to offer new insights. While such methodological and technological innovations may drive clearer and reproducible evidence within DOHaD research, as we argue, many challenges remain, including data quality, interpretability, generalisability, and ethics.
This Element examines three related topics in the field of bioethics that arise frequently both in clinical care and in medico-legal settings: capacity, informed consent, and third-party decision-making. All three of these subjects have been shaped significantly by the shift from the paternalistic models of care that dominated medicine in the United States, Canada, and Great Britain prior to the 1960s to the present models that privilege patient autonomy. Each section traces the history of one of these topics and then explores the major ethics issues that arise as these issues are addressed in contemporary clinical practice, paying particular attention to the role that structural factors such as bias and social capital play in their use. In addition, the volume also discusses recent innovations and proposals for reform that may shape these subjects in the future in response both to technological advances and changes in societal priorities.
As Steve Kaminshine said in his comments at the symposium honoring Charity Scott, I was recruited to come to Georgia State University as a “Law and Bioethics” scholar who had spent more than sixteen years shuttling between an office in a hospital and another in a law school. But when I first visited Georgia State Law, I did not know that more than ten years earlier Charity Scott had spent the better part of an academic year living and breathing clinical ethics at Grady Memorial Hospital.1 Because of her usual habit of immersion in all learning experiences, in that year Charity gained more insight into how hospitals work and how physicians behave when they are knee deep in their professional milieu of life and death decision-making than many full-time bioethics academics do in a career. For the rest of her career Charity kept one foot well planted in the medical context, as an advisor in problems of research ethics, as a teacher in her own medical-legal partnership structured around real-life clinical problems, and as an ethical analyst who could never be accused of mouthing a mantra of phrases, the “vacuous incantation of abstract principles”2 that might pass for bioethics discourse in some circles.
Anesthesiology training programs are tasked with equipping trainees with the skills to become medically and ethically competent in the practice of anesthesia and to be prepared to obtain board certification, yet there is currently no standardized ethics curriculum within anesthesia training programs in the United States. To bridge this gap, and to provide a validated ethics curriculum to meet the aforementioned needs, in July 2021, a survey was sent to anesthesia scholars in the field of biomedical ethics to identify key areas that should be included in such an ethics curriculum. The responses were rated on a Likert scale and ranked. This paper identifies the top ten topics identified as high priority for inclusion in an anesthesiology training program and consequently deemed most relevant to meet the educational needs of graduates of an anesthesiology residency: (1) capacity to consent; (2) capacity to refuse elective versus lifesaving treatment; (3) application of surrogate decisionmaking; (4) approach to do not resuscitate (DNR) status in the operating room; (5) patient autonomy and advance directives; (6) navigating patient beliefs that may impair care; (7) “futility” in end-of-life care: when to withdraw life support; (8) disclosure of medical errors; (9) clinical criteria for “brain death” and consequences of this definition; and (10) the impaired anesthesiologist.
Building a culture of conceptual inquiry in psychiatric training requires the development of conceptual competence: the ability to identify and examine assumptions that constitute the philosophical foundations of clinical care and scientific investigation in psychiatry. In this article, we argue for the importance of such competence and illustrate approaches to instilling it through examples drawn from our collective experiences as psychiatric educators.
This article aims at raising awareness about the intersection of populism and bioethics. It argues that illiberal forms of populism may have negative consequences on the evolution of bioethics as a discipline and on its practical objectives. It identifies at least seven potential negative effects: (1) The rise of populist leaders fosters “epistemological populism,” devaluing the expert and scientific perspectives on which bioethics is usually based, potentially steering policies away from evidence-based foundations. (2) The impact of “moral populism” is evident in legislative prioritization of the “morality of common people,” often solicited through popular consultations on issues like abortion, drug legalization, or LGBT issues. (3) Populist distrust in autonomous governmental agencies and advisory bodies, including national bioethics commissions, can compromise expert advice, challenging both their authority and decisions. (4) Populists may erode transparency by undermining institutions responsible for it, hindering access to vital information for bioethical research. (5) “Medical populism” creates adversarial dynamics, prompting politicians to make simplistic healthcare policy decisions based on political rather than informed criteria, adversely affecting vulnerable populations. (6) Radical-right populist parties’ “welfare chauvinism” may shape healthcare policies, impacting service access and resource allocation, disproportionately affecting vulnerable groups such as migrants, but indirectly affecting the rest of the population. (7) Nationalist sentiments associated with populism may obstruct international collaborations, posing challenges for global bioethics that seeks to address ethical concerns beyond national borders. In summary, these dynamics raise significant bioethical concerns encompassing evidence-based decision-making, transparency, healthcare equity, and global collaboration. How bioethicists may respond to these challenges is discussed.
This Element considers current legal, ethical, metaphysical, and medical controversies concerning brain death. It examines the implicit metaphysical and moral commitments and dualism implied by neurological criteria for death. When these commitments and worldview are not shared by patients and surrogates, they give rise to distrust in healthcare providers and systems, and to injustice, particularly when medicolegal definitions of death are coercively imposed on those who reject them. Ethical obligations to respect persons and patient autonomy, promote patient-centered care, foster and maintain trust, and respond to the demands of justice provide compelling ethical reasons for recognizing reasonable objections. Each section illustrates how seemingly academic debates about brain death have real, on-the-ground implications for patients and their families.
A minority of countries or parts of countries have thus far accepted the legal practice of Medical Assistance in Dying (MAiD) (euthanasia and assisted suicide), but legalising MAiD is expanding worldwide. More countries are debating legalisation of euthanasia or assisted suicide, but the nature of laws and legal practices vary greatly and both ethical and empirical assessments of current practices are the subject of much controversy. We examine the premises and evidence in the rhetoric of assisted suicide and euthanasia. We illustrate the trend with the rationale and political concerns that led to the legalisation of euthanasia in Quebec as “Medical Assistance in Dying” (MAiD), and its subsequent expansion in Canada to include persons who do not suffer from a terminal illness, including persons who suffer only from a mental illness. The values of autonomy, “dying with dignity“ and their ethical and legal bases for justifying MAiD are critically analysed. The implications of practicing euthanasia, as opposed to assisted suicide are discussed, as well as proposals for a duty to die in some circumstances. We conclude by proposing that besides debating the legal, moral and practical concerns with MAiD, we should also focus on the psychological roots of our fears and ways to reduce those fears in individuals and societies.
This Element provides an exploration of antinatalism, the view that assigns a negative value to reproduction. First, the history of Western philosophy as a two-and-a-half millennia reaction to antinatalist sentiments. Human life has no obvious meaning and philosophers have been forced to build elaborate theories to invent imaginary purposes. Second, analysis of the concept of antinatalism in the light of human extinction. If people stop having children, the species will cease to exist, and this prospect has prompted attempts to find alternatives and excuses. Third, outlines a normative view defending antinatalism both theoretically and practically. If it is wrong to bring about suffering in the absence of redeeming meaning and if it is possible to create meaning only by imposing a pronatalist mentality upon children before they can make up their own minds, parents morally corrupt themselves by procreating. This title is also available as Open Access on Cambridge Core.
When and how forcefully must we intervene to save a life, and when should we respect the will to die? This book presents alternative ethical paradigms to understand contemporary challenges in suicide research, prevention, practices, and policies, including challenges in the expanding legalization of euthanasia and assisted suicide ('medical assistance in dying'). Drawing on case studies and philosophical approaches, analysis focuses on decision-making when we are faced with questions about obligations to help and intervene in suicidal situations. Chapters cover moral dilemmas in rescue policies, ethical challenges in suicide research, civil and legal considerations, and similarities and differences with accessing medical assistance in dying. Discussion is grounded in contemporary debates, addressing important issues such as if we should continue to hospitalize people to protect them from self-harm, or control access to 'dangerous' suicide content online? This book is unique in its focus on the practical concerns of mental health professionals, helplines, researchers, policy makers, and programme planners who are faced with ethical challenges in suicidology and suicide prevention.