Pub Date : 2024-04-01Epub Date: 2023-06-08DOI: 10.1017/S0963180123000336
Sergei Shevchenko, Alexey Zhavoronkov
The paper aims to present a critical analysis of the phenomenon and notion of exceptionalism in bioethics. The authors demonstrate that exceptionalism pertains to phenomena that are not (yet) entirely familiar to us and could potentially bear risks regarding their regulation. After an overview of the state of the art, we briefly describe the origins and evolution of the concept, compared to exception and exclusion. In the second step, they look at the overall development debates on genetic exceptionalism, compared to other bioethical debates on exceptionalism, before presenting a detailed analysis of a specific case of early regulation of genetic screening. In the last part, the authors explain the historical background behind the connection between exceptionalism and exclusion in these debates. Their main conclusion is that while the initial stage of the discussion is shaped by the concept of exceptionalism and awareness of risks of exclusion, the later development centers around exceptions that are needed in detailed regulatory procedures.
{"title":"The Role of Exceptionalism in the Evolution of Bioethical Regulation.","authors":"Sergei Shevchenko, Alexey Zhavoronkov","doi":"10.1017/S0963180123000336","DOIUrl":"10.1017/S0963180123000336","url":null,"abstract":"<p><p>The paper aims to present a critical analysis of the phenomenon and notion of exceptionalism in bioethics. The authors demonstrate that exceptionalism pertains to phenomena that are not (yet) entirely familiar to us and could potentially bear risks regarding their regulation. After an overview of the state of the art, we briefly describe the origins and evolution of the concept, compared to exception and exclusion. In the second step, they look at the overall development debates on genetic exceptionalism, compared to other bioethical debates on exceptionalism, before presenting a detailed analysis of a specific case of early regulation of genetic screening. In the last part, the authors explain the historical background behind the connection between exceptionalism and exclusion in these debates. Their main conclusion is that while the initial stage of the discussion is shaped by the concept of exceptionalism and awareness of risks of exclusion, the later development centers around exceptions that are needed in detailed regulatory procedures.</p>","PeriodicalId":55300,"journal":{"name":"Cambridge Quarterly of Healthcare Ethics","volume":" ","pages":"185-197"},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9646286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2023-07-28DOI: 10.1017/S0963180123000348
Søren Holm
The question that this paper tries to answer is Q: "Can good academic bioethics be done without commitment to moral theory?" It is argued that the answer to Q is an unequivocal "Yes" for most of what we could call "critical bioethics," that is, the kind of bioethics work that primarily criticizes positions or arguments already in the literature or put forward by policymakers. The answer is also "Yes" for much of empirical bioethics. The second part of the paper then provides an analysis of Q in relation to "constructive bioethics," that is, bioethics work aimed at providing an argument for a particular position. In this part, it is argued that a number of the approaches or methods used that initially look like they involve no commitment to moral theory, nevertheless, involve such a commitment. This is shown to be the case for reflective equilibrium, mid-level theory, the use of theory fragments, and argument by analogy.
{"title":"Bioethics Without Theory?","authors":"Søren Holm","doi":"10.1017/S0963180123000348","DOIUrl":"10.1017/S0963180123000348","url":null,"abstract":"<p><p>The question that this paper tries to answer is Q: \"Can good academic bioethics be done without commitment to moral theory?\" It is argued that the answer to Q is an unequivocal \"Yes\" for most of what we could call \"critical bioethics,\" that is, the kind of bioethics work that primarily criticizes positions or arguments already in the literature or put forward by policymakers. The answer is also \"Yes\" for much of empirical bioethics. The second part of the paper then provides an analysis of Q in relation to \"constructive bioethics,\" that is, bioethics work aimed at providing an argument for a particular position. In this part, it is argued that a number of the approaches or methods used that initially look like they involve no commitment to moral theory, nevertheless, involve such a commitment. This is shown to be the case for reflective equilibrium, mid-level theory, the use of theory fragments, and argument by analogy.</p>","PeriodicalId":55300,"journal":{"name":"Cambridge Quarterly of Healthcare Ethics","volume":" ","pages":"159-166"},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9874216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2023-09-28DOI: 10.1017/S096318012300049X
Joseph J Fins
In this essay, the author reflects on a decade's old essay on baseball and bioethics inspired by a conversation with the late David Thomasma. In a reprise of his earlier paper, Fins worries that modernity has come to baseball with the advent of the pitch clock and that this innovation brings age discrimination to a timeless pastime.
{"title":"Baseball and Bioethics Revisited: The Pitch Clock and Age Discrimination in a Timeless Pastime.","authors":"Joseph J Fins","doi":"10.1017/S096318012300049X","DOIUrl":"10.1017/S096318012300049X","url":null,"abstract":"<p><p>In this essay, the author reflects on a decade's old essay on baseball and bioethics inspired by a conversation with the late David Thomasma. In a reprise of his earlier paper, Fins worries that modernity has come to baseball with the advent of the pitch clock and that this innovation brings age discrimination to a timeless pastime.</p>","PeriodicalId":55300,"journal":{"name":"Cambridge Quarterly of Healthcare Ethics","volume":" ","pages":"267-270"},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2023-07-27DOI: 10.1017/S0963180123000385
Matti Häyry, Amanda Sukenick
Antinatalism is an emerging philosophy and practice that challenges pronatalism, the prevailing philosophy and practice in reproductive matters. We explore justifications of antinatalism-the arguments from the quality of life, the risk of an intolerable life, the lack of consent, and the asymmetry of good and bad-and argue that none of them supports a concrete, understandable, and convincing moral case for not having children. We identify concentration on possible future individuals who may or may not come to be as the main culprit for the failure and suggest that the focus should be shifted to people who already exist. Pronatalism's hegemonic status in contemporary societies imposes upon us a lifestyle that we have not chosen yet find almost impossible to abandon. We explicate the nature of this imposition and consider the implications of its exposure to different stakeholders with varying stands on the practice of antinatalism. Imposition as a term has figured in reproductive debates before, but the argument from postnatal, mental, and cultural imposition we launch is new. It is the hitherto overlooked and underdeveloped justification of antinatalism that should be solid and comprehensible enough to be used even by activists in support of their work.
{"title":"Imposing a Lifestyle: A New Argument for Antinatalism.","authors":"Matti Häyry, Amanda Sukenick","doi":"10.1017/S0963180123000385","DOIUrl":"10.1017/S0963180123000385","url":null,"abstract":"<p><p>Antinatalism is an emerging philosophy and practice that challenges pronatalism, the prevailing philosophy and practice in reproductive matters. We explore justifications of antinatalism-the arguments from the quality of life, the risk of an intolerable life, the lack of consent, and the asymmetry of good and bad-and argue that none of them supports a concrete, understandable, and convincing moral case for not having children. We identify concentration on possible future individuals who may or may not come to be as the main culprit for the failure and suggest that the focus should be shifted to people who already exist. Pronatalism's hegemonic status in contemporary societies imposes upon us a lifestyle that we have not chosen yet find almost impossible to abandon. We explicate the nature of this imposition and consider the implications of its exposure to different stakeholders with varying stands on the practice of antinatalism. Imposition as a term has figured in reproductive debates before, but the argument from postnatal, mental, and cultural imposition we launch is new. It is the hitherto overlooked and underdeveloped justification of antinatalism that should be solid and comprehensible enough to be used even by activists in support of their work.</p>","PeriodicalId":55300,"journal":{"name":"Cambridge Quarterly of Healthcare Ethics","volume":" ","pages":"238-259"},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10253066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2023-10-02DOI: 10.1017/S0963180123000506
Matti Häyry, Tuija Takala
{"title":"Theories or No Theories-Is Anything Evolving?","authors":"Matti Häyry, Tuija Takala","doi":"10.1017/S0963180123000506","DOIUrl":"10.1017/S0963180123000506","url":null,"abstract":"","PeriodicalId":55300,"journal":{"name":"Cambridge Quarterly of Healthcare Ethics","volume":" ","pages":"151-157"},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41174589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2023-06-19DOI: 10.1017/S0963180123000282
Henrik Rydenfelt
Pragmatism gained considerable attention in bioethical discussions in the early 21st century. However, some dimensions and contributions of pragmatism to bioethics remain underexplored in both research and practice. It is argued that pragmatism can make a distinctive contribution to bioethics through its concept, developed by Charles S. Peirce and John Dewey, that ethical issues can be resolved through experimental inquiry. Dewey's proposal that policies can be confirmed or disconfirmed through experimentation is developed by comparing it to the confirmation of scientific hypotheses, with a focus on the objection that the consequences of following a moral view or policy do not provide guidance on choosing among competing ethical perspectives. As confirmation of scientific hypotheses typically relies on evidence gathered from observation, the possibility of ethically relevant observation is then explored based on Peirce's views on feelings as emotional interpretants. Finally, the connection between Dewey's experimental ethics and democracy is outlined and compared to unfettered ethical progressivism.
实用主义在 21 世纪初的生命伦理学讨论中获得了相当大的关注。然而,在研究和实践中,实用主义对生命伦理学的某些方面和贡献仍未得到充分发掘。本文认为,实用主义可以通过查尔斯-皮尔斯(Charles S. Peirce)和约翰-杜威(John Dewey)提出的伦理问题可以通过实验探究来解决的理念,为生命伦理学做出独特的贡献。杜威提出政策可以通过实验来确认或不确认,并将其与科学假说的确认进行了比较,重点是反对遵循道德观点或政策的后果不能为在相互竞争的伦理观点中做出选择提供指导。由于科学假说的确认通常依赖于从观察中收集的证据,因此我们将根据皮尔斯关于情感作为情感解释者的观点,探讨与伦理相关的观察的可能性。最后,概述了杜威的实验伦理学与民主之间的联系,并与不受约束的伦理进步主义进行了比较。
{"title":"Pragmatism and Experimental Bioethics.","authors":"Henrik Rydenfelt","doi":"10.1017/S0963180123000282","DOIUrl":"10.1017/S0963180123000282","url":null,"abstract":"<p><p>Pragmatism gained considerable attention in bioethical discussions in the early 21st century. However, some dimensions and contributions of pragmatism to bioethics remain underexplored in both research and practice. It is argued that pragmatism can make a distinctive contribution to bioethics through its concept, developed by Charles S. Peirce and John Dewey, that ethical issues can be resolved through experimental inquiry. Dewey's proposal that policies can be confirmed or disconfirmed through experimentation is developed by comparing it to the confirmation of scientific hypotheses, with a focus on the objection that the consequences of following a moral view or policy do not provide guidance on choosing among competing ethical perspectives. As confirmation of scientific hypotheses typically relies on evidence gathered from observation, the possibility of ethically relevant observation is then explored based on Peirce's views on feelings as emotional interpretants. Finally, the connection between Dewey's experimental ethics and democracy is outlined and compared to unfettered ethical progressivism.</p>","PeriodicalId":55300,"journal":{"name":"Cambridge Quarterly of Healthcare Ethics","volume":" ","pages":"174-184"},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9658497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2023-06-27DOI: 10.1017/S096318012300035X
Jacob M Appel
The model for capacity assessment in the United States and much of the Western world relies upon the demonstration of four skills including the ability to communicate a clear, consistent choice. Yet such assessments often occur at only one moment in time, which may result in the patient expressing a choice to the evaluator that is highly inconsistent with the patient's underlying values and goals, especially if a short-term factor (such as frustration with the hospital staff) distorts the patient's preferences momentarily. These challenges are particularly concerning in cases, which arise frequently in hospital settings, in which patients demand immediate self-discharge, often during off-hours, while faced with life-threatening risks. This paper examines the distinctive elements that shape such cases and explores their ethical implications, ultimately offering a model for such situations that can be operationalized.
{"title":"Decisional Capacity After Dark: Is Autonomy Delayed Truly Autonomy Denied?","authors":"Jacob M Appel","doi":"10.1017/S096318012300035X","DOIUrl":"10.1017/S096318012300035X","url":null,"abstract":"<p><p>The model for capacity assessment in the United States and much of the Western world relies upon the demonstration of four skills including the ability to communicate a clear, consistent choice. Yet such assessments often occur at only one moment in time, which may result in the patient expressing a choice to the evaluator that is highly inconsistent with the patient's underlying values and goals, especially if a short-term factor (such as frustration with the hospital staff) distorts the patient's preferences momentarily. These challenges are particularly concerning in cases, which arise frequently in hospital settings, in which patients demand immediate self-discharge, often during off-hours, while faced with life-threatening risks. This paper examines the distinctive elements that shape such cases and explores their ethical implications, ultimately offering a model for such situations that can be operationalized.</p>","PeriodicalId":55300,"journal":{"name":"Cambridge Quarterly of Healthcare Ethics","volume":" ","pages":"260-266"},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10045891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-01Epub Date: 2023-06-27DOI: 10.1017/S0963180123000324
John J Paris, Brian M Cummings
It took nearly two thousand years for society to recognize the Hippocratic insistence that "the doctor knows best"1 was an inadequate approach to medical decisionmaking. Today, patient-centered medicine has come to understand that the individual patient has a significant role in the decisionmaking process.2.
{"title":"A Catholic Perspective on COVID-19.","authors":"John J Paris, Brian M Cummings","doi":"10.1017/S0963180123000324","DOIUrl":"10.1017/S0963180123000324","url":null,"abstract":"<p><p>It took nearly two thousand years for society to recognize the Hippocratic insistence that \"the doctor knows best\"<sup>1</sup> was an inadequate approach to medical decisionmaking. Today, patient-centered medicine has come to understand that the individual patient has a significant role in the decisionmaking process.<sup>2</sup>.</p>","PeriodicalId":55300,"journal":{"name":"Cambridge Quarterly of Healthcare Ethics","volume":" ","pages":"285-289"},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10045890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-25DOI: 10.1017/S0963180124000173
Kelsey Gipe
Based on Nathan Goldstein's case report, "But I have a pacer…there is no point in engaging in hypothetical scenarios": A Non-imminently Dying Patient's Request for Pacemaker Deactivation, it is reasonable to conclude that it was, all-things-considered, ethically appropriate to grant the patient's request to deactivate her pacemaker. Philosophically, and as a clinical bioethicist, I support the team's decision to honor the patient's request for pacemaker deactivation. However, it is worth exploring a bit further whether the distress on the part of the outside hospital's ethics committee and providers-who declined to honor the patient's request for pacemaker deactivation-may actually track something of moral significance. Might their discomfort around deactivation be "truth-tracking" in moral terms?
{"title":"Responding to a Non-Imminently Dying Patient's Request for Pacemaker Deactivation.","authors":"Kelsey Gipe","doi":"10.1017/S0963180124000173","DOIUrl":"https://doi.org/10.1017/S0963180124000173","url":null,"abstract":"<p><p>Based on Nathan Goldstein's case report, \"But I have a pacer…there is no point in engaging in hypothetical scenarios\": A Non-imminently Dying Patient's Request for Pacemaker Deactivation, it is reasonable to conclude that it was, all-things-considered, ethically appropriate to grant the patient's request to deactivate her pacemaker. Philosophically, and as a clinical bioethicist, I support the team's decision to honor the patient's request for pacemaker deactivation. However, it is worth exploring a bit further whether the distress on the part of the outside hospital's ethics committee and providers-who declined to honor the patient's request for pacemaker deactivation-may actually track something of moral significance. Might their discomfort around deactivation be \"truth-tracking\" in moral terms?</p>","PeriodicalId":55300,"journal":{"name":"Cambridge Quarterly of Healthcare Ethics","volume":" ","pages":"1-2"},"PeriodicalIF":1.8,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140208269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-22DOI: 10.1017/S0963180124000185
Leonard M Fleck
{"title":"Bioethics and Public Policy: Is There Hope for Public Reason?","authors":"Leonard M Fleck","doi":"10.1017/S0963180124000185","DOIUrl":"https://doi.org/10.1017/S0963180124000185","url":null,"abstract":"","PeriodicalId":55300,"journal":{"name":"Cambridge Quarterly of Healthcare Ethics","volume":" ","pages":"1-6"},"PeriodicalIF":1.8,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140186387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}