Many environmental problems are now more serious and urgent than ever. In high‐income countries, health care is part of the problem. In Principles of Green Bioethics: Sustainability in Health Care, Cristina Richie focuses on medical developments, techniques, and procedures, and she proposes four principles for green bioethics: distributive justice, resource conservation, simplicity, and ethical economics. Richie is right to emphasize the need for green bioethics, and I admire her aim to bring environmental concerns back (...) into bioethics, but I was disappointed with this book. Since Plato, much of ethics has focused on the characteristics or principles of the ideally just society. This work in ethics seeks to transcend the culture in which we live in order to provide guidance about what we should do. I think it would be better to start with the messy, problematic, and unjust situations in which we are enmeshed. (shrink)

Green bioethics is an area of research and scholarship that examines the impact of healthcare practices and policies on the environment and emphasises environmental values, such as ecological sustainability and stewardship. Some green bioethicists have argued that healthcare providers should inform patients about the environmental impacts of treatments and advocate for options that minimise adverse impacts. While disclosure of information pertaining to the environmental impacts of treatments could facilitate autonomous decision-making and strengthen the patient–provider relationship in situations (...) where patients have clearly expressed environmental concerns, it may have the opposite effect in other situations if makes patients feel like they are being judged or manipulated. We argue, therefore, that there is not a generalisable duty to disclose environmental impact information to all patients during the consent process. Providers who practice green bioethics should focus on advocating for system-level changes in healthcare financing, organisation and delivery and use discretion when bringing up environmental concerns in their encounters with patients. (shrink)

Parker’s article is a welcome attempt to address the importance of environmental sustainability in the realm of clinical ethics.1 We support the recent movement to seriously consider the environmental impact of healthcare institutions in bioethics.2 3 Still, we find two partly linked weaknesses of Parker’s analysis and guideline suggestion. These relate to a need in ‘green’ bioethics to see beyond the normal healthcare ethical focus on health-related values related to individual patients, and to primarily adopt institutional ways (...) of framing central decision problems. Traditional bioethics applies a restricted scope of values to assess clinical decisions: primarily health-related patient well-being (including life) and patient autonomy. If a decision improves (or, as in Parker’s inhaler case, maintains) a patient’s health-related well-being, this supports it. However, if a decision improves a patient’s non health-related well-being, say, winning a beauty contest or securing a job by having cosmetic surgery, it is not supported. And so on. This idea of healthcare as, in Michael Walzer’s classic terminology, a separate ‘sphere of justice’ has two interrelated limitations: it reflects a bias towards individual patients over other people, and it restricts the scope of values allowed to influence healthcare ethical judgements. These limitations appear once we see that the issue addressed by Parker can be framed either as prescription decisions taken by individual doctors against the background of …. (shrink)

The ethics of medical care and biomedical research are rapidly becoming global. This volume gathers some of the world's leading bioethicists to explore many of the new questions raised by the internationalization of medical care and biomedical research. Among the topics covered are the impact of globalization on the norms of medical ethics, the conduct of international research, the ethics of international collaborations, challenges to medical professionalism in the international setting, and the relation of religion to global bioethics.

Health care is ubiquitous in the industrialized world. Yet, every medical development, technique, and procedure impacts the environment. Green bioethics synthesizes environmental ethics and biomedical ethics, thus creating an interdisciplinary approach to sustainable health care. Notably, green bioethics addresses not the structure of environmental sustainability in health-care institutions but the sustainability of individual health-care offerings. It parallels traditional biomedical ethics by providing four principles for ethical guidance: distributive justice, resource conservation, simplicity, and ethical economics. Through these (...) four principles, green bioethics presents a coherent framework for evaluating the sustainability of medical developments, techniques, and procedures. The future of our world may very well depend on how effectively we halt ecological destruction and conserve our resources in all areas of life. The principles of green bioethics, outlined in this book, will advance sustainability in health care. (shrink)

Global Bioethics gathers some of the world's leading bioethicists to explore many of the new questions raised by the globalization of medical care and ...

This discussion is a critical assessment of the methods employed by some leading writers in the field of bioethics. The author agrees with those in the field who regard its primary or essential method as moral philosophy, but he nevertheless finds a prevalent tendency among bioethical writers merely to apply received moral principles to issues and to avoid penetrating theoretical analysis, even when such analysis is unavoidably required. He explains these deficiencies in terms of the exigencies of interdisciplinary work (...) and the affinity of much early bioethics with policy- or legislatively-oriented "public ethics". The discussion ends with a call for increased theoretical sophistication in this field. Keywords: bioethics, ethics, medical ethics, method CiteULike Connotea Del.icio.us What's this? (shrink)

Background There is considerable variation in the functionality of bioethical services in different institutions and countries for children in hospital, despite new challenges due to increasing technology supports for children with serious illness and medical complexity. We aimed to understand how bioethics services address bioethical concerns that are increasingly encountered in paediatric intensive care. Methods A qualitative descriptive design was used to describe clinician’s perspectives on the functionality of clinical bioethics services for paediatric intensive care units. Clinicians who (...) were members of formal or informal clinical bioethics groups, or who were closely involved with the process of working through ethically challenging decisions, were interviewed. Interviews took place online. Resulting transcripts were analysed using thematic analysis. Results From 33 interviews, we identified four themes that described the functionality of bioethics services when a child requires technology to sustain life: striving for consensus; the importance of guidelines; a structure that facilitates a time-sensitive and relevant response; and strong leadership and teamwork. Conclusions Clinical bioethics services have the potential to expand their role due to the challenges brought by advancing medical technology and the increasing options it brings for treatment. Further work is needed to identify where and how bioethics services can evolve and adapt to fully address the needs of the decision-makers in PICU. (shrink)

Before curing was a possibility, medicine was devoted to the relief of suffering. Attention to the relief of suffering often takes a back seat in modern biomedicine. This book seeks to place suffering at the center of biomedical attention, examining suffering in its biological, psychological, clinical, religious, and ethical dimensions.

Volume 26, Issue 2, June 2020, Page 190-194.

In mid-June 2009, the Obama administration dissolved the President's Council on Bioethics (PCBE), a group established by President George W. Bush in August 2001 and whose nearly eight-year life was marked from beginning to end by controversy. While some will regret the PCBE's passing, others will regard the Council as a failed experiment in doing public bioethics.

In lieu of an abstract, here is a brief excerpt of the content:Kennedy Institute of Ethics Journal 13.4 (2003) 393-406 [Access article in PDF] U.S. Defunding of UNFPA:A Moral Analysis Ronald M. Green Ethical decisions made inside the Beltway sometimes have global consequences. Nowhere is this more true than with respect to the decision by Secretary of State Colin Powell on 21 July 2002 to halt $34 million in U.S. funding for the United Nations Population Fund (UNFPA). Behind this (...) decision lay the forces of America's abortion politics as well as tangled issues in law and bioethics.I became involved in this debate when, in early September 2003, I served as a member of a nine-person delegation of U.S. religious leaders and ethicists that traveled to China to meet with those associated with the UNFPA program there. The delegation was assembled by Frances Kissling, of Catholics for a Free Choice, which also provided support and funding for the necessary travel and administrative services. In China, our contacts included UNFPA administrators, Chinese government officials, and ordinary villagers touched by UNFPA efforts. In the middle of its week-long stay, the delegation left Beijing in three separate groups to travel to remote provincial regions (Hubei, Gansu, and Ningxia). Our goal was to respond to the Bush administration's defunding decision by deepening our understanding of the current Chinese population program and UNFPA's relationship to it. In the course of this enquiry, I encountered challenging questions that drew on my own training in ethics in novel ways. Historical Background UNFPA is the world's largest organization providing family planning and reproductive health services. It was established in 1969 as the United Nations Fund for Population Activities. In 1987, the Economic and Social Council decided to rename it the United Nations Population Fund, but to retain the original abbreviation-acronym. UNFPA works to improve access to and the quality of family planning services in more than 140 of the poorest countries in the world. It is also very active in providing services aimed at preventing the spread of HIV/AIDS. It does not provide abortion services, but works to prevent abortion through family planning and to help countries provide services for women suffering from the complications of unsafe abortion. [End Page 393]Although UNFPA is officially an agency of the United Nations, its budget, currently about $200 million per year, comes from voluntary payments by donors, including UN member states. U.S. funding has been irregular. In 1985, the U.S. House of Representatives passed a foreign operations appropriations measure that has come to be known as the "Kemp-Kasten Amendment." This measure, which has been repassed in substantially unchanged form every year since, forbids funding for "any organization or program which, as determined by the President of the United States, supports or participates in the management of a program of coercive abortion or involuntary sterilization."1 From 1986 on, the Reagan and Bush administrations halted all U.S. funding for UNFPA activities around the world on the grounds that the agency's activities in China caused it to be involved in supporting or participating in the management of a program of coercive abortion or involuntary sterilization, and, hence, put it in violation of Kemp-Kasten.Efforts by the People's Republic of China to slow the increase of its population date from the early 1970s when, in a striking departure from classical Marxist theory, which had insisted on the positive value of added labor power and denied the need for demographic controls, the government imposed a policy of delayed marriage and birth spacing. In 1979, these efforts intensified with the advent of the "one child policy." (In fact, this name is misleading since the number of children allowed a couple varies significantly from urban to rural areas, with rural residents and members of ethnic minorities permitted to have larger families.) To implement this program, the government established a National Family Planning Commission (now National Population and Family Planning Commission) which, among other things, set up a network of family planning service centers around the country, where birth control... (shrink)

When feminism rejected women’s traditional roles, it turned instead to masculine roles: a prizing of sex without commitment and an emphasis on career above family. Abortion serves both goals by keeping sex unencumbered and by freeing women from childcare demands that might limit them at work. In both cases, these might not be what women really desire.

This paper presents an overview of the key ethical questions of performing gene editing research on military service members. The recent technological advance in gene editing capabilities provided by CRISPR/Cas9 and their path towards first-in-human trials has reinvigorated the debate on human enhancement for non-medical purposes. Human performance optimization has long been a priority of military research in order to close the gap between the advancement of warfare and the limitations of human actors. In spite of this focus on temporary (...) performance improvement, biomedical enhancement is an extension of these endeavours and the ethical issues of such research should be considered. In this paper, we explore possible applications of CRISPR to military human gene editing research and how it could be specifically applied towards protection of service members against biological or chemical weapons. We analyse three normative areas including risk–benefit analysis, informed consent, and inequality of access as it relates to CRISPR applications for military research to help inform and provide considerations for military institutional review boards and policymakers. (shrink)

When does benefiting from others’ wrongdoing effectively make one a moral accomplice in their evil deeds? If stem cell research lives up to its therapeutic promise, this question (which has previously cropped up in debates over fetal tissue research or the use of Nazi research data) is likely to become a central one for opponents of embryo destruction. I argue that benefiting from wrongdoing is prima facie morally wrong under any of three conditions: (1) when the wrongdoer is one’s agent; (...) (2) when acceptance of benefit directly encourages the repetition of the wrongful deed (even though no agency relationship is involved); and (3) when acceptance of a benefit legitimates a wrongful practice. I conclude by showing that, because of the ways in which most embryonic stem cell lines come into being, people who oppose embryo destruction may use human embryonic stem cells without incurring moral blame. (shrink)

From the first initiatives in preimplantation genetic diagnosis and gene therapy through the advent of stem cell research to the development of mammalian cloning, the past two decades have witnessed remarkable advances in “reprogenetic” medicine: the union of assisted reproductive technologies with genetic control. This period has also been marked by intense debates within the bioethical literature and in national policy forums about the appropriate uses of these emerging human capabilities. We can now, in a limited way, select for genetic (...) traits, and the power to modify the genome or introduce new gene sequences is not far off. How should these new powers be used? (shrink)

Many countries currently invest in technologies and data infrastructures to foster precision medicine (PM), which is hoped to better tailor disease treatment and prevention to individual patients. But who can expect to benefit from PM? The answer depends not only on scientific developments but also on the willingness to address the problem of structural injustice. One important step is to confront the problem of underrepresentation of certain populations in PM cohorts via improved research inclusivity. Yet, we argue that the perspective (...) needs to be broadened because the (in)equitable effects of PM are also strongly contingent on wider structural factors and prioritization of healthcare strategies and resources. When (and before) implementing PM, it is crucial to attend to how the organisation of healthcare systems influences who will benefit, as well as whether PM may present challenges for a solidaristic sharing of costs and risks. We discuss these issues through a comparative lens of healthcare models and PM-initiatives in the United States, Austria, and Denmark. The analysis draws attention to how PM hinges on—and simultaneously affects—access to healthcare services, public trust in data handling, and prioritization of healthcare resources. Finally, we provide suggestions for how to mitigate foreseeable negative effects. (shrink)

In November of 1959, William Bean published in the Archives of Internal Medicine a scathing review of Félix Martí-Ibañez’s Centaur: Essays on the History of Medical Ideas. Martí-Ibañez and Bean were two of the leading exponents of the importance of medical humanism during a formative period from the 1950s through the 1970s. But the two physicians differed fundamentally in their views of the ideal relationships among the pharmaceutical industry, the medical profession, and the medical humanities. We situate Bean’s review within (...) its historical context, shedding light on the history and diverging uses of the medical humanities. (shrink)

Reproductive technologies do not allow us to choose future people, but they do change who will exist. Confusion arises because of the different senses in which ”identity’ is used in ethical debate. I distinguish qualitative, cultural, and numerical identity. Reproductive choices do impact the qualitative features of children in ways that affect wellbeing, both directly and indirectly via cultural identification. I explain how the nonidentity problem makes it difficult to say what, if anything, is wrong with risky reproductive choices, and (...) I outline four strategies or responding to the non-identity problem. (shrink)

This paper examines the ethical issues of conflict of interest raised by the burgeoning development of physician involvement in for-profit entrepreneurial activities outside their practice. After documenting the nature and extent of these activities, and their potential for conflicts of interest, the paper assesses the major arguments for and against physicians' referral of patients to facilities they own or in which they invest. The paper concludes that an outright ban on such activity seems ethically warranted.

As things currently stand, our deaths are unavoidable and our lifespans short. It might be thought that these qualities leave room for improvement. According to a prominent line of argument in philosophy, however, this thought is mistaken. Against the idea that a longer life would be better, it is claimed that negative psychological states, such as boredom, would be unavoidable if our lives were significantly longer. Against the idea that a deathless life would be better, it is claimed that such (...) a life would be lacking in important sources of value, because death is a precondition for many of our valuing attitudes. I argue that these problems are avoided by very long lives that incorporate fading memory, limited ignorance of future events, and temporal scarcity. I conclude that very long lives are, in principle, desirable, and that death does not play an essential role in our valuing attitudes. (shrink)

Last year, President Obama launched the Brain Research through Advancing Innovative Neurotechnologies Initiative with the goal of developing new technologies for studying the brain's functioning, right down to the cellular level. The President subsequently asked the Presidential Commission for the Study of Bioethical Issues to develop “a core set of ethical standards” to guide neuroscience research and its applications. This May, the PCSBI issued “Gray Matters: Integrative Approaches for Neuroscience, Ethics, and Society,” the first of a two‐volume response to this (...) request. Although “Gray Matters” mentions some of the ethical issues that together define the emerging field of neuroethics, the report as a whole may disappoint those seeking answers. It focuses almost entirely on the metaquestion of how ethics might be integrated into neuroscience research, offering four recommendations. Even as a preliminary proposal, however, the recommendations in “Gray Matters” do not go far enough. (shrink)

In the face of mounting criticism against advance directives, we describe how a novel, computer-based decision aid addresses some of these important concerns. This decision aid, Making Your Wishes Known: Planning Your Medical Future , translates an individual's values and goals into a meaningful advance directive that explicitly reflects their healthcare wishes and outlines a plan for how they wish to be treated. It does this by (1) educating users about advance care planning; (2) helping individuals identify, clarify, and prioritize (...) factors that influence their decision-making about future medical conditions; (3) explaining common end-of-life medical conditions and life-sustaining treatment; (4) helping users articulate a coherent set of wishes with regard to advance care planning—in the form of an advance directive readily interpretable by physicians; and (5) helping individuals both choose a spokesperson, and prepare to engage family, friends, and health care providers in discussions about advance care planning. (shrink)

: Debates about commodification in bioethics frequently appeal to Kant's famous second formulation of the categorical imperative, the formula requiring us to treat the rational (human) being as "an end in itself" and "never as a means only." In the course of her own treatment of commodification, Margaret Jane Radin observes that Kant's application of this formula "does not generate noncontroversial particular consequences." This is so, I argue, because Kant offers three different--and largely incompatible--interpretations of the formula. One focuses (...) on the obligation to preserve rational willing; the second stresses respect for human (physical) dignity and integrity; the third views respect for others as "ends in themselves" as primarily involving a willingness to govern one's conduct by a procedure of impartial co-legislation. Only the third of these interpretations, I conclude, offers a reasonable and coherent approach to moral judgment about the limits of commodification. (shrink)

Research partnerships between institutions in the Global North and institutions in the Global South have many potential benefits, including sharing of knowledge and resources. However, such partnerships are traditionally exploitative to varying degrees. In order to promote equity in South‐North research partnerships, it is necessary to learn from the experiences of researchers collaborating internationally. This study analyzed transcripts from eleven semi‐structured qualitative interviews with researchers working at Clínica de Familia La Romana, an institution in the Dominican Republic with decades of (...) experience with research and research partnerships with institutions from the Global North. The findings of this study suggest that respect for resources invested in research, as well as for the researchers and institutions themselves, are vital components to a successful global health research partnership. These findings have implications for individual research partnerships, as well as the policies of journals and institutions providing funding that affect these partnerships. (shrink)

In this chapter, I review some of the background thinking concerning matters of moral status that I had developed in previous years and that I would now bring to the work of the Human Embryo Research Panel. Two ideas were at the forefront of my thinking. First, that biology usually offers not decisive "events" but only continuous processes of development. Second, in making status determinations we do not so much "identify" a point on a developmental continuum where moral respect should (...) be accorded as "choose" that point. These choices are "balancing decisions" in which the community of moral agents weighs its interests in protecting an entity against the burdens of doing so. After illustrating these two contentions, I consider some of the reasons why thinkers on the "right" and "left" of our bioethics debates have resisted or missed this basic insight. (shrink)

Should research projects involving epidemiological modelling be subject to ethical scrutiny and peer review prior to publication? Mathematical modelling had considerable impacts during the COVID-19 pandemic, leading to social distancing and lockdowns. Imperial College conducted research leading to the website publication of a paper, Report 9, on non-pharmaceutical interventions (NPIs) and COVID-19 mortality demand dated 16th March 2020, arguing for a Government policy of non-pharmaceutical interventions (e.g. lockdowns, social distancing, mask wearing, working from home, furlough, school closures, reduced family interaction (...) etc.) to counter COVID 19. Enquiries and Freedom of Information requests to the institution indicate that there was no formal ethical committee review of this specific research, nor was there any peer review prior to their online publication of Report 9. This paper considers the duties placed upon researchers, institutions and research funders under the UK ‘Concordat to Support Research Integrity’ (CSRI), across various bioethical domains, and whether ethical committee scrutiny should be required for this research. (shrink)

I respond here to the essays by Karen Lebacqz and Stephen Palmquist, beginning with my debt of gratitude to Lebacqz for her understanding of the methodological depth I try to bring to the analysis of bioethical issues. I further illustrate that observation here by reviewing the logic of my approach to the issue of wrongful life. At the same time, in connection with human genetic enhancement, I acknowledge that I may have not properly appreciated the seriousness of the problem of (...) sin. To Palmquist's assertion that my criticisms of Kant's treatments of grace miss the way Kant has confined himself to being a philosophical theologian, I argue that Kant's problem lies instead in his poor application of his own compelling insights about the depths of human sinning. I close with an appreciation of Palmquist's observation of some important points of contact between Kant's understanding of sin and that of Kierkegaard. (shrink)

The concept of practical, or pragmatic, clinical trials was introduced in the early 2000s, in parallel with the growing availability and use of electronic health data. Researchers and policymakers...

In lieu of an abstract, here is a brief excerpt of the content:Bioethics Inside the BeltwayNHGRI’s Intramural Ethics ExperimentRonald M. Green (bio)Early in 1995, the National Human Genome Research Institute (then known as the National Center for Human Genome Research) began a novel experiment. It established the Office of Genome Ethics in its Division of Intramural Research (DIR). An extramural “ELSI” funding program for research on the ethical, legal, and social implications of the Human Genome Project had been (...) in existence since 1990, and a joint Department of Energy, NIH Working Group to consider larger policy issues raised by the genome project had also been in existence since that date. But the establishment of the Office of Genome Ethics was the first effort to provide an in-house ethics service for the several hundred NHGRI genetic researchers working on the NIH campus.The experiment was also novel by NIH standards. The Clinical Center, which serves all NIH research institutes as a patient-care facility, has long had a bioethics program, but, to my knowledge, none of the 23 other institutes, centers, or divisions of the NIH had ever developed an ethics program to assist its on-campus researchers in identifying and addressing the ethical issues arising from their research. Behind this initiative lay the commitment to ethics in genetic research shared by Francis Collins, Director of NHGRI, Jeff Trent, Scientific Director of the Division of Intramural Research, and other senior scientists and administrators of the Institute.I was fortunate to be asked to serve as Director of this office. My previous experience in the federal context was limited. I had served on many NIH study sections and for a nine-month period had been a member of the Human Embryo Research Panel, but none of this amounted to an “insider’s view” of government bioethics. The preponderance of my bioethics career had transpired in the university and medical school/medical center environment.Because I had to continue to fulfill many Dartmouth commitments, I agreed to serve on an interim and half-time basis (one week in Bethesda; one week at home) for an 18-month period. I was assisted in maintaining this schedule by the appointment of a deputy, Mathew Thomas, a recent bioethics graduate of Duke University, who would serve on a full-time basis and provide continuity for our [End Page 181] work. Our objectives, established in consultation with NHGRI personnel, were to learn which functions would be most useful, to set up a program to provide them, and, eventually, to aid in the process of determining how an office like this might fit into NHGRI’s future.As this 18-month stint draws to a close, I can report that it has been an exhilarating experience. I am grateful for the opportunity to have worked with outstanding scientists in an area of growing importance and interest. I believe we have pioneered in the provision of bioethics education and counsel to a diverse group of genetic researchers. We have helped to “open the doors and windows” of the Genome Institute, facilitating two-way communication between NHGRI researchers and others interested in genetic and ethics. We have assisted with some knotty problems in genetic research while building a base of knowledge about highly specialized issues that is useful to researchers inside and outside NHGRI. What follows is an abbreviated overview and evaluation of our activities during this period.Main ActivitiesWorking with a core of interested supporters from every branch of the DIR, our office quickly established a roster of activities aimed at meeting identified needs. These included: (1) a consult service able to help investigators address urgent problems arising in their research or in the IRB review process; (2) a program of workshops and discussion groups dealing with challenging ethical issues raised by genetic research; (3) a program of public seminars bringing together NHGRI researchers and other clinicians, scientists, and scholars in the greater Washington area who are interested in genetic ethics; (4) a course on science research ethics to be offered to all NHGRI personnel; and (5) an ongoing program of research activities in genetics and ethics designed to provide depth and substance to the office’s work.ConsultationsIn an institute with scores of... (shrink)

The American Journal of Bioethics, Volume 12, Issue 5, Page 8-9, May 2012.

The American Journal of Bioethics, Volume 11, Issue 8, Page 44-45, August 2011.

Prior research has documented how important it is to patients to be able to trust their physicians. In this essay, we introduce physician perspectives on the importance of earning patients’ trust. We conducted twelve semistructured interviews in late 2022, eleven with physicians and one with a patient‐experience expert. Physicians described earning patients’ trust as crucial for working effectively with patients, with several saying that it was as important as having medical knowledge. Physicians also expressed that feeling a patient trusting them (...) is professionally rewarding and fulfilling. To build trust with patients, physicians reported, they make the medical interaction all about the patient, express their belief in their patients, share their personal experiences, and use other strategies identified in previous literature: communicating effectively, being compassionate, and demonstrating competence. Physicians also reported experiencing challenges in building trust with patients, most often because of patients’ lack of trust in other levels of the health care system and because of having inadequate time to spend with patients. Additionally, Black and Brown physicians described how patients’ bias often blocks trust. (shrink)

Volume 24, Issue 8, August 2024, Page 34-36.

Science fiction is fast becoming reality as scientists and engineers seek to develop new ways of directly accessing and controlling our brains through brain-computer and even brain-to-brain interfaces. If such research is to receive continuing public approval and support—and not invite opposition—it must anticipate the special ethical challenges it creates. By pointing to some of the acute concerns raised by neural engineering technologies—around issues of identity, normality, authority, responsibility, privacy, and justice—Eran Klein and colleagues model and stimulate the kind of (...) reflection that will be needed as new brain technologies are developed. And yet, as I read their informative discussion, I find myself asking even more questions. One concerns the ethical novelty of these technologies. For example, in terms of questions of identity, normality, responsibility, and authority, how different is deep brain stimulation from the potent psychiatric drugs that have been administered for decades? How different in terms of issues of liability associated with malfunction or misuse are brain-computer interfaces from other complex devices now routinely in use? Neither ethics nor law will have to rethink things from scratch as new neural devices and capabilities are introduced: the groundwork for answering some of these questions has already been laid in a variety of fields from bioethics, to health and product liability law. Nevertheless, I conclude that there are new questions here. It is not simply the fact that neural technologies pose questions of identity, privacy, and the like but that they do so with a degree of intensity that creates qualitatively new challenges. (shrink)

My contributions to the early issues of the "Journal of Religious Ethics" display the conviction that moral judgments and religious beliefs arise from complex but comprehensible operations of practical reasoning. As this conviction has continued to ground my explorations of diverse religious traditions as well as my consideration of challenges in the domain of bioethics, I have undertaken to develop a total and coherent logic of moral judgment. Much has changed, of course, in the past quarter century, and we (...) have all had to rethink the moral boundaries of human life. These changes have, however, confirmed rather than altered my sense of the importance of bringing into view the decisional basis of practical judgments--a base that is sometimes obscured by religious traditions as they reify earlier practical decisions and ignore their decisional basis. (shrink)

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.

Throughout the Global North, policymakers invest in large-scale integration of health-data infrastructures to facilitate the reuse of clinical data for administration, research, and innovation. Debates about the ethical implications of data repurposing have focused extensively on issues of patient autonomy and privacy. We suggest that it is time to scrutinize also how the everyday work of healthcare staff is affected by political ambitions of data reuse for an increasing number of purposes, and how different purposes are prioritized. Our analysis builds (...) on ethnographic studies within the Danish healthcare system, which is internationally known for its high degree of digitalization and well-connected data infrastructures. Although data repurposing ought to be relatively seamless in this context, we demonstrate how it involves costs and trade-offs for those who produce and use health data. Even when IT systems and automation strategies are introduced to enhance efficiency and reduce data work, they can end up generating new forms of data work and fragmentation of clinically relevant information. We identify five types of data work related to the production, completion, validation, sorting, and recontextualization of health data. Each of these requires medical expertise and clinical resources. We propose that the implications for these forms of data work should be considered early in the planning stages of initiatives for large-scale data sharing and reuse, such as the European Health Data Space. We believe that political awareness of clinical costs and trade-offs related to such data work can provide better and more informed decisions about data repurposing. (shrink)