Perspectives in Biology and Medicine最新文献

This article examines the rise of the post-World War II regime for the bioethical management of research ethics. Following the Nazi crimes against humanity, a new set of regulations and expectations arose in the domain of research ethics, especially relating to the use of human subjects. These protocols centered on the invocation of informed consent, individual autonomy, and heightened peer and public review of proposed research. In the early 21st century, fundamental questions have been raised about the efficacy of this system and its "fit" with emerging new trends of precision therapeutics, complications of randomized protocols, and rising demands for the "right to try" experimental interventions. The authors assess current trends toward revision of the historical foundations of bioethics.

In recent decades, critiques of scientific universalism have grown among postcolonial scholars and epistemologists, highlighting how modern science has been used to dominate non-Western knowledge systems. The notion of "epistemicide" describes the systematic suppression of diverse epistemologies under a singular scientific worldview. Many movements now challenge science's legitimacy and endorse epistemic relativism. Yet such positions risk conflating science with its historical abuses, neglecting the distinction between robust scientific practice and pseudoscientific distortions. This essay discusses pseudoscience-defined as a discourse that mimics science but lacks rigorous methodology-as a potent tool of social oppression. Examples like eugenics, phrenology, hysteria diagnoses, "conversion therapies," and climate change denial demonstrate how pseudoscientific narratives reinforce sexism, racism, and other structural inequalities. Integrating philosophy of science, critical theory, and historical analyses, the authors argue that abandoning science is not the answer. Instead, science should be strengthened methodologically, ethically, and inclusively. By clarifying science's boundaries and exposing pseudoscience's role in social oppression, this work contributes to current debates on epistemic justice and advocates a model of science that is critically reflexive and socially transformative.

This article discusses tensions related to expectations about the health-care sector's investment in the social drivers of health. As social-care roles and responsibilities are defined, the health-care sector needs a clearer set of ethical principles to guide policy and practice. Norman Daniels's accountability for reasonableness (A4R) approach offers a framework for the development of more formal approaches, by structuring organization-wide conversations about the relevant values and providing a vocabulary for talking about the ethical dilemmas involved in questions of justice and organizational responsibility.

ABSTRACT:

Organismal superposition holds that the same individual both is and is not an organism, as a consequence of organismal pluralism. When coupled with the assumption that death is the cessation of an organism, this entails that there is no unique answer as to whether brain death is biological death. This essay argues that concerns about organismal pluralism and superposition do not undermine a theory of biological death, nor entail any metaphysical indeterminacy about the biological vital status of a brain-dead individual.

ABSTRACT:

According to the mainstream bioethical stance, death constitutes the termination of an organism. This essay argues that such an understanding of death is inappropriate in the usual context of determining death, since it also has a social bearing. There are two reasons to justify this argument. First, the mainstream bioethical definition generates an organismal superposition challenge, according to which a given patient in a single physiological state might be both alive and dead, like Schrödinger's cat. Therefore, there is no clear answer as to whether organ retrieval from a brain-dead patient is an act of killing or not. Second, when combined with the dead donor rule, the mainstream position in the definition of death might lead to ethically unacceptable verdicts, since there is a discrepancy between terminating an organism and depriving someone of moral status.

ABSTRACT:

Psychedelics, including psilocybin, and other consciousness-altering compounds such as 3,4-methylenedioxymethamphetamine (MDMA), currently are being scientifically investigated for their potential therapeutic uses, with a primary focus on measurable outcomes: for example, alleviation of symptoms or increases in self-reported well-being. Accordingly, much recent discussion about the possible value of these substances has turned on estimates of the magnitude and duration of persisting positive effects in comparison to harms. However, many have described the value of a psychedelic experience with little or no reference to such therapeutic benefits, instead seeming to find the experience valuable in its own right. How can we make sense of such testimony? Could a psychedelic experience be valuable even if there were no persisting beneficial effects? If so, how? Using the concept of psychological richness, combined with insights from the philosophy of aesthetics and the enhancement literature, this essay explores potential sources of value in the acute subjective experience, apart from the value derived from persisting beneficial effects.

ABSTRACT:

This essay explores a more inclusive and equitable interpretation of "religion" within the context of religious vaccine exemptions. The existing literature critiques the prevalent interpretation of the meaning of religion in religious exemption cases, but frequently overlooks the importance of incorporating the concept of "lived religion." This essay introduces the concept of lived religion from religious studies, elucidates why this lived religion approach is crucial for redefining "religion," and illustrates its application in the domain of religious vaccine exemptions. The author contends that broadening the meaning of religion by employing the concept of lived religion would promote a more inclusive and equitable implementation of religious vaccine exemptions.

ABSTRACT:

Psychedelics have again become a subject of widespread interest, owing to the reinvigoration of research into their traditional uses, possible medical applications, and social implications. As evidence for psychedelics' clinical potential mounts, the field has increasingly focused on searching for mechanisms to explain the effects of psychedelics and therapeutic efficacy of psychedelic-assisted therapy (PAT). This paper reviews three general frameworks that encompass several prominent models for understanding psychedelics' effects—specifically, neurobiological, psychological, and spiritual frameworks. Following our review, the implications of each framework for ethics and professional competencies in the implementation of psychedelics as medicines are explored. We suggest that interdisciplinary education may be necessary to improve communication between researchers, develop models that effectively incorporate multiple levels of analysis, and facilitate collaboration between professionals with diverse backgrounds in the implementation of psychedelic medicines. We also address pitfalls associated with overemphasis on neuro-mechanisms, risks associated with instigating vulnerable states of consciousness, and hurdles associated with the integration of spiritual frameworks in medicine. Ultimately, as psychedelics push the boundaries of explanatory frameworks focused on one level of analysis, developing new and more useful models to reflect knowledge being produced in this field should be a central aim of psychedelic science going forward.

ABSTRACT:

Most medical learned societies have endorsed both "equivalence" between all forms of withholding or withdrawing treatment and the "discontinuity" between euthanasia and practices to withhold or withdraw treatment. While the latter are morally acceptable insofar as they consist in letting the patient die, the former constitutes an illegitimate act of actively interfering with a patient's life. The moral distinction between killing and letting die has been hotly debated both conceptually and empirically, most notably by experimental philosophers, with inconclusive results. This article employs a "revisionary" intuititionist perspective to discuss the results of a clinical ethics study about intensivists' perceptions of withhold or withdraw decisions. The results show that practitioners' moral experience is at odds with both the discontinuity and equivalence theses. This outcome allows us to revisit certain concepts, such as intention and causal relationship, that are prominent in the conceptual debate. Intensivists also regard end-of-life decisions as being on a scale from least to most active, and whether they regard active forms of end-of-life decisions as ethically acceptable depends on the overarching professional values they endorse: the patient's best chances of survival, or the patient's quality of life.

ABSTRACT:

The relationship between philosophy and bioethics remains a matter of perennial debate, but there does appear to be a consensus on one issue: whatever bioethics might want to borrow from philosophical ethics, it won't be normative theories. This essay argues that theories can have an important role to play in bioethics, though it might not be the one traditionally assumed by philosophers.