Cambridge Quarterly of Healthcare Ethics最新文献

This is a personal narrative of my stroke and recovery experience, and the medical, psychological, and social circumstances surrounding it.

Studies have shown that some covertly conscious brain-injured patients, who are behaviorally unresponsive, can reply to simple questions via neuronal responses. Given the possibility of such neuronal responses, Andrew Peterson et al. have argued that there is warrant for some covertly conscious patients being included in low-stakes medical decisions using neuronal responses, which could protect and enhance their autonomy. The justification for giving credence to alleged neuronal responses must be analyzed from various perspectives, including neurology, bioethics, law, and as we suggest, philosophy of mind. In this article, we analyze the warrant for giving credence to neuronal responses from two different views in philosophy of mind. We consider how nonreductive physicalism's causal exclusion problem elicits doubt about interpreting neural activity as indicating a conscious response. By contrast, such an interpretation is supported by the mind-body powers model of neural correlates of consciousness inspired by hylomorphism.

The normative principle that every individual is equally entitled to continued life is a subject of debate in ethics, health economics and policy. We reconsider this principle in the context of setting priorities for healthcare interventions. When applied without restriction, the principle overlooks quality of life concerns entirely. However, we contend that it remains ethically relevant in certain situations, particularly when patients suffer from conditions unrelated to the therapeutic areas and treatments under consideration. Thus, we defend the principle while also emphasizing the need for its application within tight limits.

Delisted in the building directory, my name stripped from my cramped quarters just off the corpus callosum, I am impossible to find. In petitioning for official reinstatement, I have agreed to the humiliating lab investigations required for documentation. I have waved, howled, screamed, pleaded, and moaned into the latest scanners, and generally made a fool of myself. But researchers, after extensive soul-searching, and being unable to capture me as pixels and waveforms, have moved on to greener pastures. So be it. I accept official non-existence.

While the Big Bang was cooling and the laws of physics were congealing, authorities remained undecided whether God would provide comfort against the expanding darkness. To answer the question, one planet was seeded with humans equipped with conviction receptors tweaked either to an absolute faith in or complete denial of God. If, after a suitable period of mingling between the two groups, believers prevailed over doubters, God would be established in the firmament. If not, God would be scrapped.

Brain-computer interfaces (BCIs) exemplify a dual-use neurotechnology with significant potential in both civilian and military contexts. While BCIs hold promise for treating neurological conditions such as spinal cord injuries and amyotrophic lateral sclerosis in the future, military decisionmakers in countries such as the United States and China also see their potential to enhance combat capabilities. Some predict that U.S. Special Operations Forces (SOF) will be early adopters of BCI enhancements. This article argues for a shift in focus: the U.S. Special Operations Command (SOCOM) should pursue translational research of medical BCIs for treating severely injured or ill SOF personnel. After two decades of continuous military engagement and on-going high-risk operations, SOF personnel face unique injury patterns, both physical and psychological, which BCI technology could help address. The article identifies six key medical applications of BCIs that could benefit wounded SOF members and discusses the ethical implications of involving SOF personnel in translational research related to these applications. Ultimately, the article challenges the traditional civilian-military divide in neurotechnology, arguing that by collaborating more closely with military stakeholders, scientists can not only help individuals with medical needs, including servicemembers, but also play a role in shaping the future military applications of BCI technology.

Classic serotonergic psychedelics are experiencing a clinical revival, which has also revived ethical debates about psychedelic-assisted therapy. A particular issue here is how to prepare and protect patients from the vulnerability that the psychedelic state creates. This article first examines how this vulnerability manifests itself, revealing that it results from an impairment of autonomy: psychedelics diminish decision-making capacity, reduce controllability, and limit resistance to external influences. It then analyzes the strengths and weaknesses of five safety measures proposed in the literature, what aspect of the patient's vulnerability they seek to reduce, and how they can be optimized. The analysis shows that while preparatory sessions, advance directives, and specific training and oversight are useful, starting with a lower dosage and no therapy is less so. Finally, the article presents a safety measure that has been overlooked in the literature but could be highly effective and feasible: bringing a close person to the psychedelic session.

Conventional understanding and research regarding prognostic understanding too often focuses on transmission of information. However, merely overcoming barriers to patient understanding may not be sufficient. In this article the authors provide a more nuanced understanding of prognostic awareness, using oncological care as an overarching example, and discuss factors that may lead to prognostic discordance between physicians and patients. We summarize the current literature and research and present a model developed by the authors to characterize barriers to prognostic awareness. Ultimately, multiple influences on prognostic understanding may impede acceptance by patients even when adequate transfer of information takes place. Physicians should improve how they transmit prognostic information, as this information may be processed in different ways. A model of misunderstandings in awareness, ranging from patient understanding to patient belief, may be useful to guide future discussions. Future decision-making studies should consider these many variables so that interventions may be created to address all aspects of the prognostic disclosure process.

Jennifer Blumenthal-Barby (2024) has called for bioethics to end talk about personhood, asserting that such talk has the tendency to confuse and offend. It will be argued that this has only limited application for (largely) private settings. However, in other settings, theorizing about personhood leaves a gap in which there is the risk that the offending concept will get uptake elsewhere, and so the problem Blumenthal-Barby nominates may not be completely avoided. In response to this risk, an argument is presented in support of the idea that the role of philosophers and bioethicists, far from ending talk of personhood, ought to be to clarify the concept, and to do so in nuanced ways, given its application for specific kinds of impairments. The case of dementia is used to illustrate this in the context of person-centered care. Ironically, given the stigma attached to dementia, far from the need to end talk of personhood, bioethicists are needed to rescue the concept and clarify its role.