Hastings Center Report最新文献

This essay explores personal and cultural meaning in dementia through the respective stories of biomedicine, public health, and alternative worldviews, using Indigenous perspectives as a critical example. Since Alzheimer's visibility as a biomedical illness intensified in the 1970s, the disease has generated powerful narratives of scientific cure that are now limiting public discourse and appropriate social and ecological action. In this essay, our approach is rooted in the recognition that stories in their many forms (oral, written, embodied, and visual) and their associated metaphors create the semantic webs of words and actions that endow human beings with meaning. New stories from less medicalized spaces can both challenge the often-unrecognized limits and damaging behaviors of profit-driven, scientific reductionism and revitalize public and ecological health approaches based on expanded worldviews of individual, social, environmental, and indeed planetary health.

Cultural narratives about dementia reinforce the idea that people living with the condition are unreliable narrators of their own experiences. Challenges with recall and memory and changes in language that are commonly experienced by people living with dementia become equated to a loss of self. Since language is a shared space where people construct meaning through stories, stories that lack coherence or exhibit broken language are often discounted. To counter the notion that broken narratives reveal broken selves, I present a story by Marlene, a person living with dementia who recalled an encounter with a bobcat while on a camping trip. Rather than considering the veracity of her story, I focus on the importance of the emotions presented—the feeling self. Overall, I argue that by shifting focus from story challenges to expressed emotions, we are better positioned to understand and respect people living with dementia as authorities of their own experiences.

Despite elevated risk profiles for dementia, Black women are often absent in cultural narratives about dementia. This paper explores how considering multiple and intersectional cultural narratives might advance dementia research and benefit overlooked groups and communities. Using person-centered research approaches to understand the experiences of older Black women at risk for dementia may highlight conditions contributing to elevated risk, including economic precarity, racism, and caregiving responsibilities. A full recognition of cultural narratives about dementia informs better social policy, research, and practice.

This commentary argues that recent reports of an Ontario coroner's office's MAiD Death Review Committee confirm how Canada's euthanasia regime has normalized ending of life as a form of therapy, often for only indirectly health-related suffering. The author, a member of the committee, illustrates with some of the cases how access to death rather than protection against premature death appears to be prioritized, often after very basic capacity and informed consent procedures by health professionals with limited training in relevant end-of-life health care.

This article is the second in a series examining the ethical and social implications of inferring mental states from brain data. It considers two main topics. First, it discusses the challenges of extending inferences from present brain activity to mental states and from there to future mental states or behaviors. There is a risk of compounded errors when multiple inferential models are applied sequentially; harmful outcomes for minority groups underrepresented in statistical models could result. In addition, predictions based on brain data may create self-fulfilling prophecies, reinforcing neuroessentialist beliefs that undermine personal agency. Second, the paper discusses how concerns related to epistemic injustice might arise when mental states are inferred from brain data. In particular, it asks if it is just to privilege “objective” brain-based conclusions over individuals’ subjective self-reports. While brain-based evidence could empower some people to prove their claims, it may also exacerbate credibility gaps and social biases. The article concludes that careful, context-specific assessments are essential before brain-based inferences are adopted in socially significant decisions.

Following Russia's occupation of Eastern Ukraine, local health care professionals, particularly hospital administrators and public health officials, have faced criminal charges of medical collaboration for taking senior managerial positions in the occupation regime and allocating resources to the Russian army. Although Ukraine is entitled to prosecute collaborators who threaten its national security, the grounds for criminalizing medical administration during military occupation are much weaker and essentially indefensible. During occupation, international humanitarian law requires Russia to maintain adequate health care services with the assistance of local officials, protects these officials from prosecution, and ensures their independence as they weigh their professional duties to maintain essential health care for the civilian population. An analysis of representative legal cases charging health care professionals with treason and collaboration demonstrates the shortfalls of Ukrainian policy that (a) does not clearly differentiate between charges of collaboration, aiding and abetting the enemy, and treason, (b) rejects public health officials’ duty to cooperate with an occupation regime, and (c) ignores health care administrators’ right to condition their decision to cooperate on its attendant costs and benefits. Recognizing a policy of humanitarian cooperation rectifies these deficiencies by highlighting the independence of health care officials, their protection from prosecution by Ukrainian and Russian authorities, and each party's duty to maintain adequate medical care for the local population during military occupation.

Robert L. Klitzman's Doctor, Will You Pray for Me? Medicine, Chaplains, and Healing the Whole Person (Oxford University Press, 2024) offers a fervent apology for the increasingly crucial role of chaplains in contemporary health care. It weaves together anthropological data from interviews with a chaplain cohort, personal narrative, patient stories, chaplain testimony, and the social scientific study of religion. It also surfaces pointed questions about the assumptions that shape contemporary chaplaincy and the directions in which it is moving. These questions include the following: How might we clarify and strengthen the ambiguous and tensive relationship between chaplaincy and bioethics? How do we assess the normativity of the perduring Kantian/Jamesian account of religion and spirituality, which is highly individualized and emotivist? And in light of this, is chaplaincy simply becoming the institutionalized form of religion for twenty-first-century neoliberalized health care?.

This letter responds to “‘Please Baptize My Son’: The Case against Baptizing a Dying, Unconscious Atheist,” by Tate Shepherd and Michael Redinger, and “The Case for Baptizing a Dying, Unconscious Atheist,” by Abram Brummett and Nelson Jones, in the January-February 2025 issue of the Hastings Center Report.