Hastings Center Report最新文献

I present a bipartite model of organ stewardship that places it at the intersection of resource stewardship and gift stewardship. Though both forms of stewardship are grounded in relationships of trust, they are importantly distinct, as are the duties they confer. This bipartite model of organ stewardship functions as a beneficial instrument for understanding and resolving conflicts among transplant stakeholders. As proof of concept, I apply the bipartite model of organ stewardship to a controversial case of conditional organ donation, showing that we can better understand the underlying moral conflict if we recognize that it involves a tension between resource and gift stewardship. Then, demonstrating that the model can do more than just explanatory work, I use it to resolve the long-standing debate over whether organ transplant recipients are organ stewards. Although some transplant recipients are gift stewards, I argue, none are resource stewards, and they therefore do not owe anything to members of the transplant team.

On the cover: Squares of 1, 2, 3, 4 and Square Roots to 8, by Crockett Johnson, 1970–75. © Ruth Krauss Foundation

Image: Division of Medicine and Science, National Museum of American History, Smithsonian Institution

Alcohol is a class 1 carcinogen, and its use, at any level, is not safe for health. Despite this, alcohol remains strongly mixed into medical culture and is often served free at medical-community events. This presents numerous ethical concerns. First, the funding of alcohol-centered events by the medical community reinforces alcohol consumption as a coping mechanism for stress, perpetuates the perceived need for alcohol for socialization, and falsely implies that it is a safe substance. Additionally, the medical community is increasingly diverse, including Muslims, Mormons, those in recovery from substance use disorders, pregnant individuals, and individuals from homes and communities damaged by alcohol. Due to their moral or safety concerns, these individuals may miss opportunities to network and engage in professional development when alcohol is present. Therefore, alcohol acts as a barrier to diversity, equity, and inclusion efforts and can result in pernicious downstream effects for minority patient populations.

This letter responds to the essay “Language Matters: The Semantics and Politics of ‘Assisted Dying,’” by Anna M. Elsner, Charlotte E. Frank, Marc Keller, Jordan O. McCullough, and Vanessa Rampton, in the September-October 2024 issue of the Hastings Center Report.

Many of us in the modern world find ourselves implicated in massive, structural harms and injustices. We emit greenhouse gases, which—along with everyone else's emissions—are warming the planet. We buy products that result from bad labor practices. And many of us feel (appropriately, I think) some amount of guilt for our participation, but also find it difficult or impossible to fully extract ourselves from the problematic systems. I call this challenge of determining individual moral responsibility in the face of massive, structural problems “catastrophe ethics.” In this Perspective commentary, I suggest that the ubiquity of catastrophe ethics cases in the modern world justifies adopting a position of moral humility, as we recognize that none of us is morally pure but, rather, we are each choosing our own version of impurity.

The laws of medical malpractice have historically differed in significant ways from general liability laws. Until the mid-twentieth century, physician liability in the United States was limited to cases in which the doctor and patient had an established professional relationship. In the 1970s, courts and legislatures began carving out exceptions when patients posed an imminent threat to identifiable third parties. Recently, a series of cases involving circumstances such as curbside consultation, threats of violence, and automotive accidents have led some state courts to abandon the requirement of a preexisting physician-patient relationship. Instead, the courts now focus on whether foreseeable reliance is present. While these developments may significantly impact clinical practice, the connections between these cases have gone largely overlooked by both the medical and bioethics communities. This essay aims to highlight these parallel developments and to suggest that this evolution reflects a broader trend with implications far beyond the individual cases themselves.

What makes certain scientific research controversial? And when does scientific research go beyond being merely controversial to be something far worse? We propose a diagnostic framework for distinguishing between scientific research that is merely controversial and that which is abhorrent. Our framework places research projects along two axes of a value-harm map. Most research, fortunately, is both valuable and harmless. However, research may be controversial if it is either valuable but harmful or harmless but valueless. The most concerning quadrant of our value-harm map includes research that is both valueless and harmful, which is abhorrent science. The article's analysis considers a series of case studies, highlighting “new genomic race science” as an exemplar of abhorrent science.

This paper describes the unique values of, challenges within, and opportunities presented by embedded ELSI ethnography. Drawing from our six-year embedded ELSI study of the WISDOM (Women Informed to Screen Depending on Measures of Risk) trial, we present three examples of the variable ways we engaged with the WISDOM trial's scientific team. WISDOM is a preference-sensitive, pragmatic, randomized controlled trial of risk-based breast cancer screening informed by genomics. Our embedded ELSI approach included multiple modes of engagement: (a) Trial investigators sought bioethics expertise; for example, we were asked to consult on traditional bioethics topics such as consent as well as more complex questions about whether to implement a specific risk-assessment approach on only one race-defined group of trial participants. (b) As the ELSI investigators, we identified ethical concerns in issues that surfaced via ethnography and considered them in the Bioethics Working Group; for example, there were concerns about the implementation processes that the WISDOM team viewed as logistical challenges. (c) Our presence in WISDOM working group conversations and our expertise on classic social science topics, including race and gender, offered opportunities to engage on the spot with topics such as how to include transgender participants in a trial initially focused on “women's health”; through such engagement, the value of social science became clear to the trial investigators. The paper elaborates on the dynamic relationship between our ethnographic observations, the Bioethics Working Group discussions, and the contributions of each to our real-time ELSI interventions in these examples. The methods and experiences we describe here suggest modes of engagement that, in combination, have the potential to expand the role of ELSI to offer real-time intervention on issues related to equity, inclusion, and justice in genetic and genomic research.