Hastings Center Report最新文献

On the cover: Unwinding the Natural Science and History of Life, by Lynn Fellman, pigment ink digital image

Courtesy of the artist. www.FellmanStudio.com

This letter responds to the article “Neither Ethical nor Prudent: Why Not to Choose Normothermic Regional Perfusion,” by Adam Omelianchuk et al., in the July-August 2024 issue of the Hastings Center Report.

This letter responds to letters by Garson Leder and by Harrison Lee in the same issue, September-October 2024, of the Hastings Center Report.

Since 2020, physician associations have become more vocal about confronting racism, initiating a wide range of advocacy efforts, making programming changes, and issuing public statements on the topic. However, associations have directed their enthusiasm about addressing racism toward an overly broad range of statements, initiatives, and legislative advocacy. In this essay, we provide some guidance regarding which race-based actions are best suited for physicians' professional associations. We describe traits of three types of physician associations in the United States-state, specialty, and affinity-highlighting characteristics of each and discussing their strengths and weaknesses regarding different types of action around racism. It is our hope that we might direct concerned physicians toward initiatives that draw upon association strengths and that can serve as the basis for association-specific advocacy niches-and away from initiatives that enable associations to signal that they are engaged in racial-equity work without accountability or efficacy.

Combativeness is a social illness. We are surrounded by culture wars over abortion, vaccine mandates, transgender care, how we die, and even how we define death. The problem is not that we disagree, but how we disagree: too often, with anger, aggression, and a sense of urgency to win against the other. Bioethicists have the knowledge and skills needed to model constructive disagreement and respectful calls for change. Bioethicists may have increased awareness that everyone suffers from unconscious self-serving biases—we are all imperfect. They are trained to recognize competing values and to engage in processes of balancing values in social contexts. Clinical ethicists are additionally trained in mediation, which involves acknowledging goodwill, listening deeply, apologizing when needed, and seeking common ground. In short, bioethicists have many of the tools needed to be healers of a culture afflicted with combativeness.

Sport faces many challenges in creating fair, interesting, and meaningful competitions that highlight and reward the qualities widely valued in sport, such as natural talents, dedication, and competitive savvy. The Paralympic Games illuminate both the challenge and a thoughtful way of responding by organizing events that group athletes with comparable levels of impairment so that raw physical discrepancies don't overwhelm differences in talent or dedication. It may be helpful to reflect on how gender is used in decisions about who competes against whom. Gender has long served as a rough proxy for differences in size and strength. For sports where size and strength matter, those are the dimensions along which competitors should be matched, not their gender identity. In that sense, gender is incidental to fair competition in sport. Because playing sports is good for people in so many ways, we should provide abundant opportunities that are widely available and enjoyable for all people.

Normothermic regional perfusion (NRP) is a relatively new approach to procuring organs for transplantation. After circulatory death is declared, perfusion is restored to either the thoracoabdominal organs (in TA-NRP) or abdominal organs alone (in A-NRP) using extracorporeal membrane oxygenation. Simultaneously, surgeons clamp the cerebral arteries, causing a fatal brain injury. Critics claim that clamping the arteries is the proximate cause of death in violation of the dead donor rule and that the procedure is therefore unethical. We disagree. This account does not consider the myriad other factors that contribute to the death of the donor, including the presence of a fatal medical condition, the decision to withdraw life support, and the physician's actions in withdrawing life support and administering medication that may hasten death. Instead, we claim that physicians play a causative role in many of the events that lead to a patient's death and that these actions are often ethically and legally justified. We advance an “all things considered” view according to which TA-NRP may be considered ethically acceptable insofar as it avoids suffering and respects the wishes of the patient to improve the lives of others through organ donation. We conclude with a series of critical questions related to the practice of NRP and call for the development of national consensus on this issue in the United States.

“Conscientious provision” refers to situations in which clinicians wish to provide legal and professionally accepted treatments prohibited within their (usually Catholic) health care institutions. It mirrors “conscientious objection,” which refers to situations in which clinicians refuse to provide legal and professionally accepted treatments offered within their (usually secular) health care institutions. Conscientious provision is not protected by law, but conscientious objection is. In practice, this asymmetry privileges conservative religious or moral values (usually associated with objection) over secular moral values (usually associated with provision). In this article, we first argue for a legal right to one kind of conscientious provision: referral for procedures prohibited at Catholic hospitals. We then argue that a premise in that argument—the principle of comparably trivial institutional burdens—justifies legal protections for some additional forms of conscientious provision that include, for example, writing prescriptions for contraception or medical abortions. However, this principle cannot justify legal protections for other forms of conscientious provision, for instance, the right to perform surgical abortions or gender-affirming hysterectomies at Catholic hospitals.

This letter responds to the article “Beneath the Sword of Damocles: Moral Obligations of Physicians in a Post-Dobbs Landscape,” by Anne Drapkin Lyerly, Ruth R. Faden, and Michelle M. Mello, in the May-June 2024 issue of the Hastings Center Report.