The U.S. Supreme Court has likely already decided how much, if any, of President Obama's signature Affordable Care Act it is going to strike down as unconstitutional; its holding will be published this summer. No matter what the Court decides, though, it will send state and federal legislators scrambling—either to implement the law or to deal with the consequences of its alteration. There are various decisions the Court might make, but it is still most apt either to leave the ACA (...) standing, or to selectively invalidate some of its mandate‐related provisions. In either case, there will be exchanges to design and manage, subsidies to allocate, transparency standards to design and enforce. The Court's decision will thus mark the beginning, not the end, of health reform. (shrink)

Early in 2018, the Trump administration's Centers for Medicare and Medicaid Services issued a guidance letter outlining a new and controversial kind of Medicaid waiver proposal. The administration invited states to propose waivers that would impose work (or other “community engagement”) requirements as a condition of eligibility for Medicaid. The Trump administration and state proponents of work requirements want to force able‐bodied Medicaid beneficiaries into the workplace. Critics allege that this is because they mistakenly believe that low‐income individuals are not (...) working because they're lazy or because aid programs provide them with a disincentive to work. Proponents respond that the requirements can lower the public programs' costs while helping its recipients. Medicaid data seems to show that the work‐requirement proposals are a solution in search of a real‐life problem. (shrink)

Volume 20, Issue 8, August 2020, Page 72-75.

Einstein said that the most incomprehensible thing about the universe is that it is comprehensible. But was he right? Can the quantum theory of fields and Einstein's general theory of relativity, the two most accurate and successful theories in all of physics, be united in a single quantum theory of gravity? Two of the world's most famous physicists - Stephen Hawking and Roger Penrose - disagree. Here they explain their positions in a work based on six lectures with a (...) final debate, all originally presented at the Isaac Newton Institute for Mathematical Sciences at the University of Cambridge. (shrink)

Physicians who care for critically ill people with opioid use disorder frequently face medical, legal, and ethical questions related to the provision of life-saving medical care. We examine a complex medical case that illustrates these challenges in a person with relapsing injection drug use. We focus on a specific question: Is futility an appropriate and useful standard by which to determine provision of life-saving care to such individuals? If so, how should such determinations be made? If not, what alternative decisionmaking (...) framework exists? We determine that although futility has been historically utilized as a justification for withholding care in certain settings, it is not a useful standard to apply in cases involving people who use injection drugs for non-medical purposes. Instead, we are welladvised to explore each patient's situation in a holistic approach that includes the patient, family members, and care providers in the decision-making process. The scope of the problem illustrated demonstrates the urgent need to definitively improve outcomes in people who use injection drugs. Increasing access to high quality medication-assisted treatment and psychiatric care for individuals with opioid use disorder will help our patients achieve a sustained remission and allow us to reach this goal. (shrink)

Friesen et al. (2023) article explores tensions within institutional review boards (IRBs) when they aim both to protect participants from harm and to include under-represented populations in clinic...

Over 115 000 people are waiting for life-saving organ transplants, of whom a small fraction will receive transplants and many others will die while waiting. Existing efforts to expand the number of available organs, including increasing the number of registered donors and procuring organs in uncontrolled environments, are crucial but unlikely to address the shortage in the near future and will not improve donor/recipient compatibility or organ quality. If successful, organ bioengineering can solve the shortage and improve functional outcomes. Studying (...) manufactured organs in animal models has produced valuable data, but is not sufficient to understand viability in humans. Before risking manufactured organ experimentation in living humans, study of bioengineered organs in recently deceased humans would facilitate evaluation of the function of engineered tissues and the complex interactions between the host and the transplanted tissue. Although such studies do not pose risk to human subjects, they pose unique ethical challenges concerning the previous wishes of the deceased, rights of surviving family members, effective operation and fair distribution of medical services, and public transparency. This article investigates the ethical, legal and social considerations in performing engineered organ research on the recently deceased. (shrink)

We agree with Nielsen Busch and Mjaaland’s (2023) assessment that the Dead Donor Rule (DDR) should be viewed as an essential requirement of the organ donation process, and that the essence of the r...

This article offers some general criticisms of the idea that any political theory can legitimate public health interventions, and then some particular criticisms of Civic Republicanism as a political theory for public health. Civic Republicanism, I argue, legitimizes liberty-infringing public health interventions by demanding high levels of civic engagement in framing and reviewing them; to demand such engagement in pursuit of such a baseline value as health will leave insufficient civic energy for the pursuit of higher values.

We claim that if a complete philosophy of evidence-based practice is intended, then attention to the nature of causation in health science is necessary. We identify how health science currently conceptualises causation by the way it prioritises some research methods over others. We then show how the current understanding of what causation is serves to constrain scientific progress. An alternative account of causation is offered. This is one of dispositionalism. We claim that by understanding causation from a dispositionalist stance, many (...) of the processes within an evidence-based practice framework are better accounted for. Further, some of the problems associated with the health research, e.g. external validity of causal findings, dissolve. (shrink)

We welcome and applaud Wilkinson’s impressive and subtle exploration of the possible considerations of frailty as a criterion for triage in times of pandemic-dr...

Volume 20, Issue 10, October 2020, Page 39-41.

Every country's law permits medical experimentation on animals. While some countries protect particular kinds of animals from being subject to experimentation—notably great apes and endangered species—very few place concrete limitations on what researchers may cause animals to suffer, given sufficient scientific justification. What laws do, instead, is establish standards for the humane treatment and housing of animals in labs, and they encourage researchers to limit or seek alternatives to the use of animals, when doing that is consistent with the scientific (...) goals of their research.The system that has evolved in the United States combines elements of sometimes competing regulatory philosophies. The result is a complex, multilayered system that addresses the most important concerns, but, partly because of historical accident, also leaves some gaps. Even proponents of medical research on animals can see obvious ways in which the regulatory structure could be changed to benefit animals. Perhaps more important, though, is the fact that the existing regulatory structure, imperfect though it may be, is elastic enough to accommodate substantial changes that could reduce unnecessary animal suffering. (shrink)

This article examines the emerging possibility of “brain-state transitioning,” in which one brain state is prompted through manipulating the dynamics of the active brain. The technique, still in its infancy, is intended to provide the basis for novel treatments for brain-based disorders. Although a detailed literature exists covering topics around brain-machine interfaces, where targets of brain-based activity include artificial limbs, hardware, and software, there is less concentration on the brain itself as a target for instrumental intervention. This article examines some (...) of the science behind brain-state transitioning, before extending beyond current possibilities in order to explore philosophical and ethical questions about how transitions could be seen to impact on assessment of responsibility and personal identity. It concludes with some thoughts on how best to pursue this nascent approach while accounting for the philosophical and ethical issues. (shrink)

The question of whether the normative testimony of ethics experts should be admissible under the rules of evidence has been the subject of much debate. Professor Imwinkelried's paper is an effort to get us, for a moment, to change that subject. He seeks to turn our attention, instead, to a means by which bioethics experts’ normative analyses might come before the court without regard to the rules of evidence - a means lying formally outside those rules’ jurisdiction. The court, he (...) argues, may freely consider evidence from expert bioethicists so long as it is performing a legislative rather than an adjudicative function. The rules of evidence apply to the court's efforts to find the facts of a particular case, Imwinkelried argues, but they do not constrain the court's investigations relative to its creative law-making efforts. (shrink)

The question of whether the normative testimony of ethics experts should be admissible under the rules of evidence has been the subject of much debate. Professor Imwinkelried's paper is an effort to get us, for a moment, to change that subject. He seeks to turn our attention, instead, to a means by which bioethics experts’ normative analyses might come before the court without regard to the rules of evidence - a means lying formally outside those rules’ jurisdiction. The court, he (...) argues, may freely consider evidence from expert bioethicists so long as it is performing a legislative rather than an adjudicative function. The rules of evidence apply to the court's efforts to find the facts of a particular case, Imwinkelried argues, but they do not constrain the court's investigations relative to its creative law-making efforts. (shrink)

Bringing together 20 foundational texts in contemporary modernist criticism in one accessible volume, this book explores the debates that have transformed the field of modernist studies at the turn of the millennium and into the 21st century. The New Modernist Studies Reader features chapters covering the major topics central to the study of modernism today, including: Feminism, gender and sexuality; Empire and race; Print and media cultures; Historical and geographical debates. Each text includes an introductory summary of its historical and (...) intellectual contexts, as well as guides to further reading to help students and teachers explore the ideas further. Includes essential texts by leading critics such as: Pascale Casanova, Anne Anlin Cheng, Brent Hayes Edwards, Rita Felski, Susan Stanford Friedman, Mark Goble, Miriam Hansen, Andreas Huyssen, David James, Fredric Jameson, Heather K. Love, Douglas Mao, Mark S. Morrisson, Michael North, Jessica Pressman, Lawrence Rainey, Paul K. Saint-Amour, Bonnie Kime Scott, Urmila Seshagiri, Robert Spoo, and Rebecca Walkowitz. (shrink)

This bibliography constitutes the most extensive compilation of references on Nathaniel Branden yet published.

Three states—Oregon, Washington, and Vermont—have used straightforwardly democratic means to legalize the practice formerly known as “physician‐assisted suicide” but now termed “aid‐in‐dying.” In two states—Montana and New Mexico—aid‐in‐dying has been declared legal neither by directly democratic action by citizens nor by representatively democratic action by the legislature but by court rulings in cases brought by aid‐in‐dying activists. The court case in New Mexico (Morris v. New Mexico, 2014) is undoubtedly of greater significance to the rest of the states. The Morris (...) opinion is as interesting for what it declined to hold as for what it held. (shrink)

Ethicists and physicians all over the world have been working on triage protocols to plan for the possibility that the Covid‐19 pandemic will result in shortages of intensive care unit beds, ventilators, blood products, or medications. In reflecting on those protocols, many health care workers have noticed that, outside the pandemic shortage situation, we routinely supply patients in the ICU with invasive and painful care that will not help the patients survive even their hospitalization. This is the kind of pointless (...) care that even the most basic protocol would triage against. Perhaps this widespread reflection on triage standards will draw our attention to our ongoing custom of supplying burdensome and inefficacious care to those near the end of life—care that most health care providers would not want for themselves. This essay argues that reflecting on triage could help us improve end‐of‐life care. (shrink)

For the past few years I've had the distinct privilege to edit the Hastings Center Report's Policy & Politics column. The column—as indicated by a little block of text at its end—was originally conceived as, and remains, a joint production of HCR and the American Society for Bioethics and Humanities. For me, as column editor, this means that I can accept contributions only from ASBH members. Luckily this presents me with an extremely large pool of talent from which to draw! (...) I am very proud of the fact that a large majority of contributors to the column in the last several years had never written in HCR before I invited them to contribute. But naturally, I don't know everyone, and I can't keep track of everything. I'd love to get even more unsolicited offers of P&P contributions than I already enjoy. (shrink)

In bioethics as in other areas of health policy, historical institutional factors can shape policy independently of interests or public opinion. This article finds policy divergence among countries with similar national moral views of stem cell research, and explains that divergence as the product of path-dependency.

My aim in this paper is simply to show that, in bioethics no less than in other areas of health care, policy in democracies is shaped not only by principles and values, but also — and to some extent independently — by the shape and history of particular political institutions and past policies. “Path dependency,” or what one scholar has called the “accidental logics” of already-existing institutions, condition and guide national policy choices. These institutional and historical pressures can even create (...) substantial policy divergences between quite likeminded nations. I shall illustrate the point using some comparative data about national policies regarding research on human embryonic stem cells. The fact that gaps can develop between values and policies is readily visible to anyone who compares national stemcell research policies to the expressed attitudes of the citizens of various democratic countries regarding human embryonic stem-cell research. The role of path dependency and the accidental logics of institutional structure in creating those gaps can be illustrated by tracking down the details of the development of human embryonic stem cell policies in a few different countries. (shrink)

The prelims comprise: Introduction: The Moral Arbitrariness of Health Status Justice as a Social Virtue Libertarian and Conservative Arguments Utilitarian Approaches to Justice in Health Care Finance Rawls' s Theory of Justice Justice and the Social Determinants of Health The Capabilities Approach International Justice and Health Conclusion References.

These are hard days for globalism. A major candidate for the United States presidency ran on an anti-immigration, anti-free-trade platform and denounced such venerable international institutions as the North Atlantic Treaty Organization and the United Nations. The European Union is under threat after the vote for Brexit; the Euro is under strain. China is denouncing and ignoring the result of an international arbitration over its claims to the South China Sea. Nationalist, xenophobic political parties are in the ascendency around the (...) world, buoyed by the fears and pains of populations for whom global trade has been no boon and to whom waves of new immigrants seem threatening both economically and socially. So it is both strange and uplifting, in this atmosphere, to encounter the ambitious and enthusiastic globalism of Lawrence Gostin's important, field-founding work, Global Health Law. Equal parts encyclopedia and manifesto, the book seeks both to provide exhaustive and up-to-date descriptions of the already-substantial body of international health law and of its implementing institutions and to chart Gostin's vision for their vigorous expansion. And that vision is nothing if not expansive. (shrink)

Volume 20, Issue 8, August 2020, Page 23-25.

In the United States, while it is legal for physicians to prescribe drugs for “off-label” indications (uses for which the drugs do not have Food and Drug Administration approval), it is largely—though not entirely—illegal for drug manufacturers to promote off-label uses of their drugs to physicians. In recent months, the rules against off-label marketing have been rigorously enforced: in October, Allergan reached a $375 million settlement over off-label promotion of Botox; in September, Novartis settled an off-label marketing dispute for $422.5 (...) million, and Forest Laboratories settled one for $313 million. These were only the latest in a series of criminal and civil settlements on off-label promotion, the most .. (shrink)

On the fourth day of his presidency, Donald Trump reinstated and greatly expanded the “Mexico City policy,” which imposes antiabortion restrictions on U.S. foreign health aid. In general, the policy has prohibited U.S. funding of any family-planning groups that use even non-U.S. funds to perform abortions; prohibited aid recipients from lobbying for liberalization of abortion laws; prohibited nongovernment organizations from creating educational materials on abortion as a family-planning method; and prohibited health workers from referring patients for legal abortions in any (...) cases other than rape, incest, or to save the life of the mother. The policy's prohibition on giving aid to any organization that performs abortions is aimed at limiting alleged indirect funding of abortions. The argument is that if U.S. money is used to fund nonabortion programs of an abortion-providing NGO, then the NGO can simply shift the money thus saved into its abortion budget. Outside the context of abortion, we do not reason this way. And the policy's remaining three prohibitions are deeply troubling. (shrink)

A response to “Normalizing Aid-in-Dying within the Practice of Medicine,” by Kathryn L. Tucker.

Reply to a commentary by Timothy F. Murphy.