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The Role of Exceptionalism in the Evolution of Bioethical Regulation. 例外论在生物伦理法规演变中的作用。
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-01 Epub Date: 2023-06-08 DOI: 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.

本文旨在对生命伦理学中的例外论现象和概念进行批判性分析。作者指出,例外论与我们尚未完全熟悉的现象有关,可能会带来监管方面的风险。在概述了该领域的现状之后,我们简要介绍了这一概念的起源和演变,并与例外和排斥进行了比较。第二步,与其他关于例外论的生命伦理辩论相比,他们考察了关于基因例外论的整体发展辩论,然后对基因筛查早期监管的一个具体案例进行了详细分析。在最后一部分,作者解释了这些辩论中例外论与排斥之间联系的历史背景。他们的主要结论是,讨论的最初阶段是由例外论的概念和对排斥风险的认识所决定的,而后来的发展则围绕着详细监管程序中所需的例外情况。
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引用次数: 0
Bioethics Without Theory? 没有理论的生命伦理学?
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-01 Epub Date: 2023-07-28 DOI: 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.

本文试图回答的问题是:"如果不致力于道德理论,能否开展好的生命伦理学学术研究?本文认为,对于我们可以称之为 "批判性生命伦理学 "的大部分工作来说,Q 的答案是明确的 "是",也就是说,对于主要批判文献中已有的或决策者提出的立场或论点的生命伦理学工作来说,Q 的答案是明确的 "是"。对于大部分实证生物伦理学来说,答案也是 "是"。论文的第二部分分析了 Q 与 "建设性生命伦理学 "的关系,即旨在为某一特定立场提供论据的生命伦理学著作。在这一部分中,论文认为,所使用的一些方式或方法最初看起来似乎并不涉及对道德理论的承诺,但实际上却涉及这种承诺。反思性平衡、中层理论、理论片段的使用以及类比论证就是这种情况。
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引用次数: 0
Baseball and Bioethics Revisited: The Pitch Clock and Age Discrimination in a Timeless Pastime. 棒球与生物伦理学再谈:永恒的业余时间里的球场时钟与年龄歧视。
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-01 Epub Date: 2023-09-28 DOI: 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.

在这篇文章中,作者回顾了一篇关于棒球和生物伦理学的十年前的文章,这篇文章的灵感来自于与已故的大卫·托马斯马的对话。在重复他早期的论文时,Fins担心随着球场时钟的出现,棒球已经变得现代,这种创新将年龄歧视带到了一种永恒的消遣中。
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引用次数: 0
Imposing a Lifestyle: A New Argument for Antinatalism. 强加一种生活方式:反生育主义的新论点。
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-01 Epub Date: 2023-07-27 DOI: 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.

反生育主义是一种新兴的哲学和实践,它对生育问题上的主流哲学和实践--代孕主义提出了挑战。我们探讨了反生育主义的理由,包括生命质量、无法忍受的生命风险、未经同意、好坏不对称等,并认为这些理由都不能为不生育提供具体、可理解和令人信服的道德理由。我们认为,把注意力集中在未来可能出现也可能不会出现的个体身上是失败的罪魁祸首,并建议把注意力转移到已经存在的人身上。生育主义在当代社会中的霸权地位将一种我们并未选择却几乎无法放弃的生活方式强加于我们。我们将阐释这种强加的本质,并考虑其对不同利益相关者的影响,这些利益相关者对反生育主义的实践持有不同的立场。作为一个术语,"强加"(imposition)曾经出现在生育问题的辩论中,但我们从产后、精神和文化强加的角度提出的论点却是全新的。它是迄今为止被忽视和发展不足的反生育主义的理由,它应该足够坚实和易懂,甚至可以被活动家用来支持他们的工作。
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引用次数: 0
Theories or No Theories-Is Anything Evolving? 理论还是没有理论有什么在进化?
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-01 Epub Date: 2023-10-02 DOI: 10.1017/S0963180123000506
Matti Häyry, Tuija Takala
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引用次数: 0
Pragmatism and Experimental Bioethics. 实用主义与实验生物伦理学。
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-01 Epub Date: 2023-06-19 DOI: 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。
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引用次数: 0
Decisional Capacity After Dark: Is Autonomy Delayed Truly Autonomy Denied? 天黑后的决策能力:自主权被延迟就真的被剥夺了吗?
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-01 Epub Date: 2023-06-27 DOI: 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.

美国和大部分西方国家的行为能力评估模式依赖于四种技能的展示,包括表达清楚、一致选择的能力。然而,这种评估往往只发生在某一时刻,这可能会导致病人向评估者表达的选择与病人的基本价值观和目标极不一致,尤其是当短期因素(如对医院工作人员的不满)瞬间扭曲了病人的偏好时更是如此。在医院环境中经常出现的情况是,病人要求立即自行出院,而且往往是在非工作时间,同时还面临着危及生命的风险,在这种情况下,这些挑战尤其令人担忧。本文研究了形成此类情况的独特因素,并探讨了其伦理影响,最终为此类情况提供了一个可操作的模式。
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引用次数: 0
A Catholic Perspective on COVID-19. 从天主教角度看 COVID-19。
IF 1.5 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-04-01 Epub Date: 2023-06-27 DOI: 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.

近两千年后,社会才认识到希波克拉底人坚持的 "医生最清楚 "1 是一种不适当的医疗决策方法。如今,以患者为中心的医学已经认识到,患者个人在决策过程中发挥着重要作用。
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引用次数: 0
Responding to a Non-Imminently Dying Patient's Request for Pacemaker Deactivation. 回应非临终病人停用起搏器的请求。
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-03-25 DOI: 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?

根据 Nathan Goldstein 的病例报告 "但我有心脏起搏器......进行假设是没有意义的":一位非临终病人要求停用起搏器》一文,我们有理由得出结论:从所有方面考虑,同意病人停用起搏器的请求在伦理上是适当的。从哲学上讲,作为一名临床生物伦理学家,我支持医疗团队同意患者停用起搏器请求的决定。然而,值得进一步探讨的是,外院伦理委员会和医护人员拒绝满足患者停用起搏器的要求,他们的苦恼实际上是否具有道德意义。他们对停用起搏器的不安是否可能是道德意义上的 "真相追踪"?
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引用次数: 0
Bioethics and Public Policy: Is There Hope for Public Reason? 生物伦理与公共政策:公共理性还有希望吗?
IF 1.8 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-03-22 DOI: 10.1017/S0963180124000185
Leonard M Fleck
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引用次数: 0
期刊
Cambridge Quarterly of Healthcare Ethics
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