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Conscience, Disobedience, and Standard of Care 良知、不服从和护理标准。
IF 2.3 3区 哲学 Q1 ETHICS Pub Date : 2024-08-08 DOI: 10.1002/hast.4903
Stephen R. Latham

In the article “Principled Conscientious Provision: Referral Symmetry and Its Implications for Protecting Secular Conscience,” Abram L. Brummett, Tanner Hafen, and Mark C. Navin reject what they call the “referral asymmetry” in U.S. conscientious objection law in medicine, which recognizes rights of conscientiously objecting physicians to withhold referrals for medical interventions but does not (yet) recognize rights of physicians to make referrals for medical interventions to which they are morally committed but to which their health care institutions are morally opposed. This commentary concentrates on a second asymmetry, namely, the relationship of a health care provider's referral or nonreferral to the medical standard of care. The commentary argues that this second asymmetry seems to require action more appropriately recognized as civil disobedience than conscientious provision of referral.

在 "有原则的良心规定:Abram L. Brummett、Tanner Hafen 和 Mark C. Navin 反对他们所称的美国依良心拒服兵役法中的 "转诊不对称",该法承认依良心拒服兵役的医生有权拒绝转诊医疗干预,但(尚未)承认医生有权转诊他们在道德上承诺但其医疗机构在道德上反对的医疗干预。本评论集中讨论第二个不对称问题,即医疗服务提供者转诊或不转诊与医疗标准的关系。评注认为,这第二种不对称似乎要求采取的行动更适合被视为公民不服从,而不是出于良心提供转诊。
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引用次数: 0
Conscience, Caricatures, and Catholic Identities 良知、漫画和天主教徒的身份。
IF 2.3 3区 哲学 Q1 ETHICS Pub Date : 2024-08-08 DOI: 10.1002/hast.4904
Cory D. Mitchell

Catholic health care is often viewed as antithetical to secular conceptions of autonomy. This view can engender calls to protect “choice” in Catholic facilities. However, this view is built on a fundamental misunderstanding of the Ethical and Religious Directives for Catholic Health Care Services (ERDs). This commentary, which responds to “Principled Conscientious Provision: Referral Symmetry and Its Implications for Protecting Secular Conscience,” by Abram Brummett et al., seeks to demonstrate the nuance of the ERDs as well as to address some of the challenges various Catholic identities have when interpreting and living out the ERDs so that all patients receive high-quality, compassionate care. By highlighting the Church's desire to protect all people at every stage, I hope to dispel the caricatures that often result from misunderstandings by Catholics and non-Catholics alike.

天主教医疗保健通常被视为与世俗的自治理念背道而驰。这种观点会引发保护天主教机构中的 "选择 "的呼声。然而,这种观点建立在对《天主教医疗服务伦理与宗教指令》(ERDs)的根本误解之上。本评论是对 "有原则的良心供应 "的回应:Abram Brummett 等人撰写的 "转介对称性及其对保护世俗良知的影响 "一文的评论,旨在展示ERDs的细微差别,并解决各种天主教身份在解释和践行ERDs时所面临的一些挑战,从而使所有患者都能获得高质量、富有同情心的医疗服务。通过强调教会在每个阶段保护所有人的愿望,我希望能够消除天主教徒和非天主教徒因误解而经常产生的漫画形象。
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引用次数: 0
On Normothermic Regional Perfusion 关于常温区域灌注
IF 2.3 3区 哲学 Q1 ETHICS Pub Date : 2024-07-19 DOI: 10.1002/hast.1601
Garson Leder

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.

这封信回应了《黑斯廷斯中心报告》2024 年 7-8 月刊上亚当-奥梅里安丘克等人撰写的文章《既不道德也不谨慎:为什么不选择常温区域灌注",作者 Adam Omelianchuk 等,发表于 2024 年 7-8 月刊的《黑斯廷斯中心报告》。
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引用次数: 0
Anti-obesity Medications: Ethical, Policy, and Public Health Concerns 抗肥胖药物:伦理、政策和公共卫生问题。
IF 3.3 3区 哲学 Q1 ETHICS Pub Date : 2024-06-06 DOI: 10.1002/hast.1588
Robert Klitzman, Henry Greenberg

New anti-obesity medications (AOMs) have received widespread acclaim in medical journals and the media, but they also raise critical ethical, public health, and public policy concerns that have largely been ignored. AOMs are very costly, need to be taken by a patient in perpetuity (since significant rebound weight gain otherwise occurs), and threaten to shift resources and focus away from other crucial efforts at obesity treatment and prevention. Many people may feel less motivated to exercise or reduce their caloric consumption, if they assume that obesity is now medically treatable. Policy-makers may similarly come to feel that the solution to the obesity pandemic is simply to prescribe medications and that prevention efforts are far less necessary. These drugs raise concerns about justice (since AOMs will disproportionately benefit the wealthy), medicalization, and marketing. Policy-makers, clinicians, and others need to engage in multipronged educational and policy efforts to address these challenges.

新型抗肥胖药物(AOMs)在医学期刊和媒体上广受赞誉,但它们也引发了道德、公共卫生和公共政策方面的重大问题,而这些问题在很大程度上被忽视了。AOMs 费用高昂,患者需要长期服用(否则会出现体重大幅反弹),而且有可能将资源和重点从其他治疗和预防肥胖症的重要工作上转移开。如果许多人认为肥胖症现在是可以通过药物治疗的,那么他们锻炼身体或减少热量消耗的积极性可能会降低。政策制定者可能同样会认为,解决肥胖问题的办法就是简单地开药,而预防工作的必要性要小得多。这些药物引起了人们对公正(因为 AOMs 将使富人受益过多)、医疗化和营销的担忧。政策制定者、临床医生和其他人员需要在教育和政策方面多管齐下,以应对这些挑战。
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引用次数: 0
Issue Information and About the Cover Art 发行信息和关于封面艺术
IF 3.3 3区 哲学 Q1 ETHICS Pub Date : 2024-06-06 DOI: 10.1002/hast.1599

On the cover: Soul Searching, by Liz McDonald, 2021, acrylic on canvas, 20 × 20 inches.

Courtesy of the artist. lizmcdonaldstudio.com

封面上:搜魂》,Liz McDonald 创作,2021 年,布面丙烯,20 × 20 英寸。由艺术家提供。lizmcdonaldstudio.com
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引用次数: 0
Policy, Politics, and Impact 政策、政治和影响
IF 3.3 3区 哲学 Q1 ETHICS Pub Date : 2024-06-06 DOI: 10.1002/hast.1585
Susan Gilbert

The work of bioethicists often involves identifying an ethical problem in health or medicine and proposing a policy to address it. But the path to policy is full of twists and turns, bumps and detours. Effecting policy may be the goal, but it is far from assured. One success story is discussed here. The U.S. Department of Health and Human Services issued a ruling in April 2024 that requires all teaching hospitals in the country to get written consent from patients before they undergo intimate medical exams. The ruling was informed by an essay in the Hastings Center Report two years ago that revealed that millions of U.S. residents have received unconsented intimate exams and that this unethical practice occurs nearly four times as often in Black patients as White patients.

生物伦理学家的工作往往涉及确定卫生或医学中的伦理问题,并提出解决该问题的政策建议。但是,制定政策的道路充满曲折、坎坷和迂回。制定政策可能是目标,但远非万无一失。这里讨论一个成功案例。美国卫生与公众服务部于 2024 年 4 月发布了一项裁决,要求国内所有教学医院在对患者进行私密医疗检查之前,必须获得患者的书面同意。两年前,《黑斯廷斯中心报告》(Hastings Center Report)中的一篇文章披露,数百万美国居民在未经同意的情况下接受了私密检查,而这种不道德的做法在黑人患者中的发生率几乎是白人患者的四倍。
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引用次数: 0
Better Conversations for Better Informed Consent: Talking with Surgical Patients 更好的对话,更好的知情同意:与手术患者交谈。
IF 3.3 3区 哲学 Q1 ETHICS Pub Date : 2024-06-06 DOI: 10.1002/hast.1587
Margaret L. Schwarze, Robert M. Arnold, Justin T. Clapp, Jacqueline M. Kruser

For more than sixty years, surgeons have used bioethical strategies to promote patient self-determination, many of these now collectively described as “informed consent.” Yet the core framework—understanding, risks, benefits, and alternatives—fails to support patients in deliberation about treatment. We find that surgeons translate this framework into an overly complicated technical explanation of disease and treatment and an overly simplified narrative that surgery will “fix” the problem. They omit critical information about the goals and downsides of surgery and present untenable options as a matter of patient choice. We propose a novel framework called “better conversations.” Herein, surgeons provide context about clinical norms, establish the goals of surgery, and comprehensively delineate the downsides of surgery to generate a deliberative space for patients to consider whether surgery is right for them. This paradigm shift meets the standards for informed consent, supports deliberation, and allows patients to anticipate and prepare for the experience of treatment.

六十多年来,外科医生一直在使用生物伦理策略来促进病人的自我决定,其中许多策略现在被统称为 "知情同意"。然而,"知情同意 "的核心框架--理解、风险、益处和替代方案--却无法支持患者对治疗进行深思熟虑。我们发现,外科医生将这一框架转化为对疾病和治疗的过于复杂的技术解释,以及手术将 "解决 "问题的过于简化的叙述。他们忽略了关于手术目标和弊端的关键信息,并将站不住脚的选择作为患者的选择事项。我们提出了一个名为 "更好的对话 "的新框架。在这个框架中,外科医生会提供临床规范的背景信息,确定手术的目标,并全面阐述手术的弊端,从而为患者提供一个慎重考虑的空间,让他们考虑手术是否适合自己。这种模式的转变符合知情同意的标准,支持深思熟虑,并让患者对治疗体验有所预期和准备。
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引用次数: 0
Nancy S. Jecker, Zohar Lederman, and Anita Ho reply Nancy S. Jecker、Zohar Lederman 和 Anita Ho 回答。
IF 3.3 3区 哲学 Q1 ETHICS Pub Date : 2024-06-06 DOI: 10.1002/hast.1595
Nancy S. Jecker, Zohar Lederman, Anita Ho

This letter replies to the letter “Colonial and Neocolonial Barriers to Companion Digital Humans in Africa,” by Luís Cordeiro-Rodrigues, in the same, May-June 2024, issue of the Hastings Center Report.

这封信是对路易斯-科代罗-罗德里格斯(Luís Cordeiro-Rodrigues)在 2024 年 5-6 月同一期《黑斯廷斯中心报告》上发表的题为 "非洲数字人类伴侣的殖民和新殖民障碍 "一文的回复。
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引用次数: 0
Abigail Levin replies 阿比盖尔-莱文回复
IF 3.3 3区 哲学 Q1 ETHICS Pub Date : 2024-06-06 DOI: 10.1002/hast.1597
Abigail Levin

This letter responds to the letter “The Open Donor View and Procreative Beneficence,” by Daniel Groll, in the same, May-June 2024, issue of the Hastings Center Report.

这封信是对丹尼尔-格罗尔(Daniel Groll)在 2024 年 5 月至 6 月同一期《黑斯廷斯中心报告》上发表的 "开放捐赠者观点与生育福利 "一文的回应。
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引用次数: 0
Breaking Binaries: The Critical Need for Feminist Bioethics in Pediatric Gender-Affirming Care 打破二元对立:儿科性别平等护理中对女权主义生命伦理学的迫切需求》(Breaking Binaries: The Critical Need for Feminist Bioethics in Pediatric Gender-Affirming Care)。
IF 3.3 3区 哲学 Q1 ETHICS Pub Date : 2024-06-06 DOI: 10.1002/hast.1591
Lisa Campo-Engelstein, Grayson R. Jackson, Jacob D. Moses

This commentary responds to Moti Gorin's article “What Is the Aim of Pediatric ‘Gender-Affirming’ Care?” We argue that Gorin's case against pediatric gender-affirming care rests upon numerous false conceptual binaries: female/male, public/private, objective/subjective, and medically necessary/elective. Drawing on feminist bioethics, we show how such dichotomous thinking is both inaccurate and marginalizing of gender minorities.

这篇评论回应了莫蒂-戈林(Moti Gorin)的文章 "儿科'性别确认'护理的目的是什么?我们认为,戈林反对儿科性别确认护理的理由建立在许多错误的概念二元对立之上:女性/男性、公共/私人、客观/主观、医学上必要/选择。借鉴女权主义生命伦理学,我们展示了这种二分法思维是如何既不准确又边缘化性别少数群体的。
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Hastings Center Report
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