The ethics literature and professional guidelines call for extensive discussions prior to prescreening consent to prenatal cell-free DNA screening to, theoretically, allow patients to make decisions that match their values and goals of care. Most patients, however, actively avoid in-depth moral deliberation when consenting to prenatal screening and then receive a screen-negative result, suggesting that an information-heavy process is irrelevant for average-risk pregnancies. In addition, extensive information-based consent procedures are not feasible in many resource-limited contexts. Meanwhile, patients and families with screen-positive results frequently report minimal support following screening, resulting in long-term distress and suboptimal outcomes. We argue for a fundamental shift to an approach we call “just-in-time consent”: identifying the essential information for values-based decisions prior to screening while relocating resources and moral deliberation to when families receive screen-positive results. This model both ensures that patients and families receive support when they most need it and maintains high standards for the ethical provision of prenatal genetic screening.
Since the U.S. Supreme Court's decision in Dobbs v. Jackson Women's Health Organization, the popular media has been flooded with stories about pregnant patients experiencing obstetric complications who were denied access to necessary abortion care and suffered tragic consequences. Yet some of the lesser-told relevant stories include far subtler impacts on the patient-physician relationship. In this commentary, I reflect on interviews that my team and I conducted with general obstetrician-gynecologists in states with near-total bans on abortion. They shared their sense that abortion bans had resulted in an imaginary “third person” in the room, haunting the clinical encounter and intervening in care. I suggest that post-Dobbs abortion bans drive a wedge into the physician-patient relationship that is figuratively embodied by invoking the “third person” in the room.
Medical science has delivered extraordinary advances during my forty-year career as a medical oncologist. But might the science's justified prestige unhelpfully diminish our respect for other needed forms for understanding the human experience? This is a critical issue for physicians, who may be present with patients at moments of profound existential challenge. By equating hope with scientific progress and limiting its own role to purveyor of the latest that science has on offer, the medical profession may unwittingly add to the burden on patients with advanced cancer. Humanistic understandings of hope drawn from philosophy, theology, and literature serve as essential—at their best, equally true—partners to the portrait offered by experimental science. Physicians, in their manner of interacting with patients, may serve as both messengers of and models for a deeper understanding of hope that fully embodies the significance of human life and sustains patients when they most need support.
Proponents of the expressivist objection argue that the use and provision of testing to select against disability in offspring express negative judgments about existing persons with disabilities. But does the expression of such judgments also wrong those persons? This paper argues that whether the expressivist objection succeeds will ultimately depend on whether a plausible explanation can be supplied for how persons with disabilities are wronged by the expression of negative judgments and that the literature on relational egalitarianism can supply such an explanation, albeit with important limitations.
The Road to Wisdom: On Truth, Science, Faith, and Trust, the optimistic title of Francis S. Collins's new book, hides a realistic appraisal of our current polarized country. Collins tries to tackle, in everyday language, why people are having such a hard time figuring out what is truth, how to think about science, how religious faith fits into this, and how and whom we can trust. “Misinformation, disinformation, fear … are constantly trying to knock us into the ditch,” he observes. His prescriptions are personalized and actionable—for example, talking to a neighbor whose views are different from yours.