Theoretical Medicine and Bioethics最新文献

A movement asking to take race out of medicine is growing in the US. While we agree with the necessity to get rid of flawed assumptions about biological race that pervade automatic race correction in medical algorithms, we urge caution about insisting on a blanket eliminativism about race in medicine. If we look at racism as a fundamental cause, in the sense that this notion has been introduced in epidemiological studies by Bruce Link and Jo Phelan, we must conclude that race is indispensable to consider, investigate, and denounce the health effects of multilevel racism, and cannot be eliminated by addressing more specific risk factors in socially responsible epidemiology and clinical medicine. This does not mean that realism about human races is vindicated. While maintaining that there are no human races, we show how it is that a non-referring concept can nonetheless turn out indispensable for explaining real phenomena.

In her controversial paper, Anna Smajdor proposes that brain-dead people could be used as gestation units for prospective parents unable or unwilling to undertake the act themselves-what she terms whole body gestational donation (WBGD). She explores the ethical issues of such an idea and, comparing it with traditional organ donation, asserts that such deceased surrogacy could be a way of outsourcing pregnancy's harms to a populace unable to be affected by them. She argues that if the prospect is unacceptable, this may reveal some underlying problems with traditional cadaveric organ donation. Smajdor's analysis, however, overlooks several problems arising from WBGD. This paper provides an account of those issues and argues that, in addition to WBGD being viscerally unpleasant, it is also ethically unviable. The paper starts by providing an account of WBGD before acknowledging its negative response within traditional and social media. After arguing that such cursory and gut reactions are insufficient to reject the proposal outright, this paper then provides three concerns regarding WBGD omitted by Smajdor: (i) the co-opting of life-saving organs for reproduction, (ii) the discrepancy between using cadaveric organs to save a life versus creating one, and (iii) the universalization of feminist concerns regarding reproductive body commodification. The paper concludes by tentatively agreeing with Smajdor that considering WBGD may help reveal vulnerable assumptions regarding organ donation and surrogacy, but that the significant ethical issues raised may prove insurmountable and make the intervention-thought experiment or otherwise-untenable.

Anna Smajdor's proposal of whole body gestational donation (WBGD) states that female patients diagnosed as brain-dead should be considered for use as gestational donors. In this response, Smajdor's proposal is rejected on four different accounts: (a) the debated acceptability of surrogacy despite women's autonomy, (b) the harm to dead women ́s interests, (c) the interests of the descendants, and (d) the symbolic value of the body and interests of relatives. The first part argues that WBGD rests on a particular conception of the instrumentalization of bodies that cannot be circumvented simply by the patient's consent and relinquished autonomy. The second part argues the importance of avoiding any harm to dead women's interests. The third part identifies the importance of the interest of the foetus in the light of Procreative-Beneficence principle that Smajdor overlooks. And finally, the fourth part considers the symbolic value of the human body and the interest of relatives. The main goal of this commentary is not to show that WBGD cannot be implemented; rather, it is to show that there are not any good arguments in favour of doing so.

'Shared' decision-making is heralded as the gold standard of how medical decisions should be reached, yet how does one 'share' a decision when any attempt to do so will undermine autonomous decision-making? And what exactly is being shared? While some authors have described parallels in literature, philosophical examination of shared agency remains largely uninvestigated as an explanation in bioethics. In the following, shared decision-making will be explained as occurring when a group, generally comprised of a patient and or their family, and the medical team become a genuine intentional subject which acts as a collective agent. Collective agency can better explain how some medical decisions are reached, contrary to the traditional understanding and operationalization of 'autonomy' in bioethics. Paradoxically, this often occurs in the setting of high-stakes moral decision-making, where conventional wisdom would suggest individuals would most want to exercise autonomous action according to their personally held values and beliefs. This explication of shared decision-making suggests a social ontology ought to inform or displace significant aspects of autonomy as construed in bioethics. It will be argued that joint commitments are a fundamental part of human life, informing and explaining much human behavior, and thus suggesting that autonomy - conceived of as discrete, individuated moral reasoning of a singular moral agent - is not an unalloyed 'good.'