Hastings Center Report最新文献

In the twentieth century, following the development of advanced life-support technology, recognition of perimortem states such as brain death challenged traditional definitions of death. A series of debates in the 1960s and 1970s regarding the need to adapt the social and legal frameworks in the face of new medical capabilities culminated in the publication and widespread adoption of the Uniform Determination of Death Act. However, in the interests of uniformity, the drafters of the UDDA compromised its internal conceptual clarity in favor of ensuring that the UDDA was broadly acceptable. A uniform statute proposed by James Bernat and collaborators in the 1980s demonstrates that increased clarity regarding underlying philosophical commitments in a model statute could help to resolve this confusion.

This commentary, which responds to the article “Models of Relational Medical Decision-Making: Caregivers and Advanced Life-Sustaining Treatment,” by Aaron Wightman and Georgina Campelia, in the same issue of this journal, argues for reorienting medical decision-making around care rather than patient autonomy alone. Drawing on empirical studies and disability bioethics, it asserts that most patients prefer involving physicians and caregivers in decision-making. Empirical studies show that many patients prefer physician-directed or collaborative decisions and commonly weigh the input of caregivers. Additionally, patients frequently factor the potential burden on family into difficult treatment choices, undermining strict substituted decision-making. Normatively, focusing on care acknowledges human dependency and the moral significance of caregiving, which resists ableist tendencies that render carers invisible. The author endorses Wightman and Campelia's care-centered model, showing that it better reflects actual decision-making practices and validates dependence and caregivers’ labor.

In “Models of Relational Medical Decision-Making: Caregivers and Advanced Life-Sustaining Treatment,” Aaron Wightman and Georgina Campelia describe a set of increasingly nuanced models for decision-making about advanced life-sustaining technologies when unpaid familial or other relational medical caregivers are required for patient welfare. Decision-making poses many challenges for caregivers, care recipients, and clinicians. Here, I discuss three related to the possibility that a presumed caregiver might say no: coercive circumstances that make “refusal” challenging as a live possibility, difficulties with the “informed” part of a caregiver's informed consent and refusal, and the possibility that caregiving of this sort is ultimately shot through with inevitable moral failures not because the caregiver is a bad person or making bad choices but rather because such caregiving is all too often a case of when doing the right thing is impossible.

The metaphor of “food is medicine” underlies a broad range of efforts to integrate nutrition into patient-care planning. The metaphor reflects the fact that good nutrition can be as important to health as are drugs and other medical interventions. It also reminds us that, like medicines, many foods are highly processed industrial products backed by powerful commercial interests. Yet, because food is different from medicine in important respects, embedding access to nutrition into programs designed to deliver medical services is an imperfect solution. Harnessing the potential benefits of nutrition for health will require a broader approach not limited to the health sector alone.

In The AI Mirror: How to Reclaim Our Humanity in an Age of Machine Thinking, Shannon Vallor excavates the moral significance of the difference between experiences such as cognition, empathy, and love that emerge in embodied beings like us, and simulacra of those experiences as produced by bodiless systems like generative AIs. She argues, helpfully and powerfully, that there is no greater existential threat to humanity than failing to remember and preserve that difference.

On the cover: The Complexity of Things 2, by Mirella Rylewicz, 2011, acrylic on canvas, 100 × 112 cm.

Courtesy of the artist. https://mirellarylewicz.com

The Alabama Supreme Court recently held that embryos are children for purposes of the state's Wrongful Death of a Minor Act, causing in vitro fertilization (IVF) clinics to halt operations. While an emergency measure was passed to allow fertility services to resume, the governor made clear that it was a temporary fix and that regulations could follow. Indeed, some argue that IVF would have to be outlawed given the risk of loss of embryonic life inherent therein. But lawmakers could use the doctrine of double effect to justify IVF as a means of assisting people to have children notwithstanding a foreseen but unintended risk of loss of embryonic life. Even still, if governments intend to take embryonic personhood seriously, legislatures will have to make difficult decisions about whether certain activities such as cryopreservation, preimplantation genetic screening, and multiembryo transfers ought to be restricted to mitigate the risk of embryonic loss.

As global science leaders revisit the fourteen-day rule for human embryo research, this commentary explores why its clarity, stability, and the public trust it has fostered have made it a notable success in science policy—and why any change must be approached with care.

In recent years, participant engagement initiatives in research on implanted neural devices have significantly increased. However, there remains little consensus on the motivations, goals, and best practices for engagement efforts. Drawing on the concept of participatory epistemic injustice, we argue that one core ethical motivation for engagement is epistemic in nature. Based on their subject positions, participants should be key knowledge contributors to implanted neurotech research. Therefore, we argue, participants experience participatory epistemic injustice when their insights do not result in changes to or otherwise influence research protocols, device development, and task design. We contend that engagement can resist this type of injustice only if it establishes robust methods not only to gather but also to actively incorporate participant knowledge into the research and development process.

In the summer of 2018, the Minneapolis Star Tribune reported clinical trials at Hennepin County Medical Center in which emergency medical personnel were injecting agitated individuals with ketamine, often at the urging of police. These individuals were enrolled in the trials without their knowledge or consent. In one of the studies, nearly 40 percent of subjects given ketamine experienced breathing issues so serious that they had to be intubated. Many subjects were members of vulnerable, marginalized groups. In this paper, we describe the ways in which the Hennepin Healthcare ketamine studies violated federal research guidelines. We consider the troubling relationship between Hennepin Healthcare and law enforcement, as well as the concept of excited delirium. Finally, we consider some alternative ways of conceptualizing clinical trials in which the intervention may not benefit subjects. We compare the ketamine trials to clinical trials of chemical restraints in nursing homes and other health care institutions and also to studies of “nonlethal” weapons.