Essays and articles in the November‐December 2022 issue of the Hastings Center Report explore the complexities of medical decision‐making. A case‐study essay, for example, argues that the dismaying decision to perform resuscitation efforts on a patient who had obviously been dead for some time can be understood in the context of the harmful practice of defensive medicine. A narrative essay concerns whether an adolescent with locked‐in syndrome should be asked her wishes about life‐sustaining interventions, and the articles illuminate the ethical (...) value of the parental role in pediatric decision‐making, an array of ways in which patient decision‐making is interdependent, and the limitations of measures designed to evaluate the quality of a patient's decision and decision‐making process. (shrink)

Hastings Center Report, Volume 52, Issue 1, Page 2-2, January/February 2022.

In the Hastings Center Report's July‐August 2022 issue, articles by Jessica Amalraj and Kavita Shah Arora and by Inmaculada de Melo‐Martín take up very different concerns under the broad topic of reproductive ethics and public policy. Amalraj and Arora call for public deliberation and consensus building to revise a Medicaid sterilization policy, and de Melo‐Martín argues that social resources should not be used to support reproductive embryo editing but should instead be put toward pre‐ and postnatal interventions that, compared to (...) embryonic genome editing, can help far more people have children who are healthy and genetically related to them. The third article, by Bryan Sisk and James M. DuBois, offers a framework to guide clinicians in their everyday communication with patients and their family members. Elsewhere in the issue are arguments about the responsibilities health care organizations have to address large societal problems affecting well‐being. (shrink)

In the lead article of the May‐June 2021 issue of the Hastings Center Report, Nancy Jecker and Caesar Atuire argue that the Covid‐19 crisis is best understood as a syndemic, “a convergence of biosocial forces that interact with one another to produce and exacerbate clinical disease and prognosis.” A syndemic framework, the authors advise, will enable bioethicists to recognize the ethical principles that should guide efforts to reduce the unequal effects that Covid‐19 has on populations. Drawing on sub‐Saharan African conceptions (...) of solidarity, the authors lay out an approach to global vaccine distribution that prioritizes low‐ and middle‐income countries. Like Jecker and Atuire's article, an essay by philosopher Keisha Ray pushes bioethicists to recognize broader justice‐oriented responsibilities with the aid of a wide‐angle lens. Ray's essay focuses on contemporary examples of environmental injustices that sicken, disable, or kill Black people. (shrink)

This January‐February 2020 issue marks the start of the Hastings Center Report's fiftieth volume. The issue introduces the column Looking Back, Looking Forward, which we plan to run in this volume only. Conceived by Hastings Center fellows Douglas Diekema and Lainie Friedman Ross, the column will explore the significance of landmark publications from the first fifty years of bioethics. For the first installment, Diekema looks at the unconventional moral position Hans Jonas took in his 1969 essay “Philosophical Reflections on Experimenting (...) with Human Subjects.” In the lead article, “Trust, Risk, and Race in American Medicine,” Laura Specker Sullivan contextualizes patient mistrust within a history of racism in general and in the nation's biomedical research and clinical institutions specifically. Specker Sullivan proposes ways for individual clinicians to improve relationships with distrustful patients and their families. Two commentaries provide additional insights and recommendations about the work of earning patient trust. (shrink)

Two articles in this issue of the Hastings Center Report (May‐June 2018) argue that having knowledge of genetic mutations can entail a moral responsibility to rescue others. In the lead article, Madison Kilbride, a philosopher at the Perelman School of Medicine, assigns to the patient, under certain conditions, a task physicians are prohibited from taking on without patient consent: to disclose a finding of a serious, clinically actionable genetic mutation to the patient's relatives who are likely to have the same (...) mutation. Kilbride emphasizes that the responsibility to family members that comes with such a finding has nothing to do with special obligations, duties to people with whom one has special relationships, such as people one lives with, works with, or loves. Rather, Kilbride maintains, the patient's duty to warn is grounded, in the principle of rescue; “another person … who just happens to be the patient's relative … is at risk of suffering serious harm.” In an article on disclosing incidental findings, Haley Sullivan and Benjamin Berkman, both at the National Institutes of Health, consider the ethical professional responsibility of those conducting genetic research on human subjects in low‐ and middle‐income countries, where many people are made vulnerable by the scarcity and inferiority of medical and other resources. (shrink)

The lead article in this issue discusses a potentially free metaphorical space—that of decision-making—within the confines, tangible and intangible, of life in jail or prison. By interviewing prisoner-participants from six clinical studies, Paul Christopher and colleagues sought to find out how these men and women would answer open-ended questions about their decision to enroll in the research. What the interviewers heard was that none saw themselves as having been inappropriately pressured to do so. In fact, a significant percentage of the (...) prisoners described being dissuaded from participating in the studies. The authors therefore advise that unfair exploitation poses the more relevant research risk to contemporary prisoners in the United States than does coercion, and they encourage investigations into whether prisoners are unfairly restricted or discouraged from joining clinical studies. Although Keramet Reiter makes no reference to etymology in her commentary responding to the article, her argument suggests that the roots of “coerce”—the Latin for “shut up” or “enclose”—remain relevant. Reiter argues that, under current conditions, the people shut up in prisons in the United States cannot make an unfettered choice to join a clinical trial. (shrink)

Over email a few days after the death of Daniel Callahan, cofounder of The Hastings Center and for many years its director and then president, Joseph Fins, a longtime Hastings colleague, offered this comfort: “[H]enceforth every issue of the Report is a living memorial to Dan the writer, editor, and institution builder.” In the Hastings Center Report's first issue, published in June 1971, Dan stated, “To say that [the work of the Report] must be multi‐disciplinary is only to say the (...) issues [it will address] are as complex as human beings themselves.” This July–August 2019 issue continues the tradition Dan began. An essay by Laura Guidry‐Grimes expands on the importance of interdisciplinary conversations and problem solving—and attends to the complexity of human beings—in recalling a patient who was failed by multiple social institutions. In the lead article, a team of authors led by James Sabin identifies a challenge to conducting ethical research within learning health organizations, where research and care are integrated with the aid of patient data from health insurance providers. (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)