Decisions concerning children in the health care setting have engendered significant controversy and sparked ethics policies and statements, legal action, and guidelines regarding who ought to make decisions involving children and how such decisions ought to be made. Traditionally, parents have been the default decision-makers for children not only with regard to health care but with regard to other matters, such as religious practice and education. In recent decades, there has been a steady trend away from the view that parents (...) are in authority over their children and toward the view that children are rights-bearers who should be granted greater authority over themselves. The mature minor doctrine refers to the decision to grant mature minors the authority to make decisions traditionally reserved for their parents. This essay (1) documents the trend towards expanding the understanding of some minors as “mature” and hence as having the right and authority to give informed consent, (2) examines the reasons for which some commentators have a special interest in expanding the mature minor doctrine to the research setting and allowing minors to enroll in research without parental permission, and (3) defends the view that the mature minor doctrine, regardless of its application to clinical health care decisions, ought to be set aside in the research setting in favor of greater parental involvement. (shrink)

Traditionally, people were recognized as being dead using cardio-respiratory criteria: individuals who had permanently stopped breathing and whose heart had permanently stopped beating were dead. Technological developments in the middle of the twentieth century and the advent of the intensive care unit made it possible to sustain cardio-respiratory and other functions in patients with severe brain injury who previously would have lost such functions permanently shortly after sustaining a brain injury. What could and should physicians caring for such patients do? (...) Significant advances in human organ transplantation also played direct and indirect roles in discussions regarding the care of such patients. Because successful transplantation requires that organs be removed from cadavers shortly after death to avoid organ damage due to loss of oxygen, there has been keen interest in knowing precisely when people are dead so that organs could be removed. Criteria for declaring death using neurological criteria developed, and today a whole brain definition of death is widely used and recognized by all 50 states in the United States as an acceptable way to determine death. We explore the ongoing debate over definitions of death, particularly over brain death or death determined using neurological criteria, and the relationship between definitions of death and organ transplantation. (shrink)

Clinical investigators must engage in just subject recruitment and selection and avoid unduly influencing research participation. There may be tension between the practice of keeping payments to participants low to avoid undue influence and the requirements of justice when recruiting normal healthy volunteers for phase 1 drug studies. By intentionally keeping payments low to avoid unduly influenced participation, investigators, on the recommendation or insistence of institutional review boards, may be targeting or systematically recruiting healthy adult members of lower socio-economic groups (...) for participation in phase 1 studies. Investigators are at risk of routinely failing to fulfill the obligation of justice, which prohibits the systematic targeting and recruiting of subjects for reasons unrelated to the nature of the study. Insofar as we take seriously the obligation to engage in just subject recruitment and selection, I argue that we must acknowledge the implications low payments might have for subject recruitment and selection and examine the effect of low payments. If low payments de facto target the less well-off for phase 1 studies, we must defend the priority ranking of the obligation to avoid undue influence over the obligation of justice or adopt an alternative recruitment approach. This paper identifies a number of alternatives to the current system of low-value payments to research participants. (shrink)

(No abstract is available for this citation).

Public bioethics focuses on deliberating about, recommending, or establishing social policies or practices concerning health care and biotechnology. A brace of premises underlies much of the work of public bioethics. First, there is the view that, if one approaches reality and human life as if both were without ultimate significance, one will find that one shares a common public bioethics. That is, if one abstains not only from any religious concerns, but even from philosophical reflections on the circumstance that life (...) might have ultimate meaning, one will be able to articulate a common neutral moral perspective that all persons can share and that can be the basis of a common public bioethics. The second premise is that the controversies in bioethics arise from the presence of religious belief, especially Christian belief, which supports a set of moral commitments that generate controversies that make the framing of public policy difficult. The view is that there is significant disagreement among persons who hold religious positions, particularly Christians, and that in public bioethics we should strive to eliminate these controversies by relying on a neutral moral framework. This paper documents and challenges these premises. It demonstrates that Christian bioethics finds itself already embedded in the field of secular moral controversy before it adds the perspectives it brings. (shrink)

Decisions by industry sponsors to end clinical trials early for commercial reasons have been the subject of controversy. I argue that the principal consideration in assessing these decisions ought to be the way in which the termination would affect the trial’s risk–benefit relationship. If there is not yet sufficient benefit to be gained from the study to offset the risks to which participants were exposed and it is expected that important scientific information would be obtained if the trial were continued, (...) early termination constitutes an unethical alteration of the risk−benefit relationship. This violates the grounds on which permission is given to conduct human research, patients consent to participate, and investigators agree to conduct studies. These knowable and avoidable changes in risk–benefit relationship should generally be seen as impermissible. (shrink)

Peter Dabrock argues that western Christian roots have shaped the western European mindset, that of believers and secular thinkers alike, such that (1) western Europeans hold the concept of human dignity as a central moral category and believe that respect for human dignity should frame social and political decisions and respect for human dignity is the foundation of bioethics, (2) Christians and secular thinkers can engage each other on secular terms using the shared language and focus on human dignity, and (...) (3) such engagement using a common moral focus/lens facilitates dialogue and convergence on issues in bioethics. Dabrock's analysis and conclusions raise a number of important points for discussion. This essay examines three elements of his analysis that are particularly important for assessing his overall claim about a common Christian and secular morality in western Europe and for understanding the relationship between such a vision and Christian bioethics. (shrink)

Health care reform poses numerous challenges. A core challenge is to make health care more efficient and effective without causing more harm than benefit. Additionally, those fashioning health-care policy must encourage patients to exercise caution and restraint when expending scarce resources; restrict the ability of politicians to advance their careers by promising alluring but costly entitlements, many of which they will not be able to deliver; face the demographic challenges of an aging population; and avoid regulations that create significant inefficiencies (...) and restrict access to health care. Given such real-world challenges, how should health care be reformed in the United States or elsewhere? This number of The Journal of Medicine and Philosophy examines many of the complex issues that must be considered in reforming a health-care system. (shrink)