Theoretical Medicine and Bioethics最新文献

According to 2021 data, the United States' opt-in system of posthumous organ donation results in seventeen Americans dying each day waiting for vital organs, while many good undonated organs go to the grave with the corpse. One of the most aggressive, and compelling, proposals to resolve this tragedy is postmortem organ conscription, also called routine salvaging or organ draft. This proposal entails postmortem retrieval of needed organs, regardless of the prior authorization or refusal of the deceased or his family. The argument of most proponents of conscription relies heavily upon a denial of the possibility of posthumous harms. While I also deny the possibility of posthumous harms, I argue this denial fails to acknowledge other serious wrongs that could be done to the deceased person and his corpse. While the person can no longer be harmed, his life, in a roughly biographical sense, can be damaged. Humans highly value life in this sense, often more than biological life. Respect for this sense of life also informs appropriate treatment of particular human corpses, which already have special value beyond mere resource. I will argue that conscription proponents fail to appropriately value lives and human corpses. This failure can lead to multiple wrongs, among them a wrongful exploitation of the vulnerability of a person's life and corpse and a disrespect of persons. While it is possible that some biographical lives could be made better, or at least less bad, by conscription, the judgments such decisions would require make conscription bad policy.

I offer a principled objection to arguments in favour of legalizing non-voluntary euthanasia on the basis of the principle of beneficence. The objection is that the status of death as a benefit to people who cannot formulate a desire to die is more problematic than pain management care. I ground this objection on epistemic and political arguments. Namely, I argue that death is relatively more unknowable, and the benefits it confers more subjectively debatable, than pain management. I am not primarily referring to the claim that it is difficult to make comparisons between live and post-mortem states, but rather to the fact that it is epistemically and metaphysically problematic to impute a "life-worse-than-death" or a state of "suffering-calling-for-death" to people who cannot subjectively wish to die, as though this kind of suffering were a medically observable fact rather than a belief- and value-laden notion. On the contrary, people enduring similar causes of pain may have different experiences of suffering and views on how it affects the worthwhileness of their existence or the desirability of death or of continuing their lives. The projection of a "suffering-calling-for-death" onto infants or people with severe intellectual disabilities may not be indefensible, but it is more controversial than judging that pain management will improve their well-being from the perspective of beneficence. My argument also relies on our society's liberal endeavour to avoid endorsing unverifiable beliefs about life and death or controversial conceptions of the good life. My goal is not to suggest we should not attend the suffering of cognitively disabled people. On the contrary, I only cast doubt on too quick an assumption that ending their lives is the best way of caring for them, when robust palliative treatments are available. Moreover, I express the concern that a lack of attention to distinctions between "pain-calling-for-relief" and "suffering-calling-for-death" may be based on ableist projections and assumptions. I conclude that it is imperative to continue research into the nature of pain and suffering experienced by individuals with mental or cognitive impairments preventing them from expressing autonomous wishes about the kind of treatment that would most benefit them.

Well before patient-centered or patient-controlled research became trendy, and earlier than calls to preferentially refer to research subjects as participants, Bob Veatch wrote "The Patient as Partner" Veatch presciently argued that research patients should not be thought of as passive subjects nor material from which to obtain data, but rather as partners in discovery. In this manuscript, I will explore Veatch's conception of patient as partner in research and how that idea has evolved and been implemented over time and consider some of the remaining challenges. Complexities of patient partnership include: clarifying the types of research in which patient partnership is most appropriate, recognizing the various possible levels of patient engagement in each case, avoiding tokenism and striving for respectful partnership, and keeping in mind the appropriate implementation of protections and safeguards. Bob Veatch would be pleased with the progress that has been made in creating research partnerships with patients, while also undoubtedly pushing us to continue to do better.