With 40 years in public service, and 23 years on the Senate Foreign Relations committee, Richard Lugar's career and views are of particular interest today, when the U.S. must be particularly careful to choose a wise course of foreign policy. In this collection of essays, distinguished scholars, government officials, public servants and businessmen honor the man who sees Teddy Roosevelt's 'big stick...not as a substitute for good sense, but an expression of it, ' in addition to analyzing the U.S.'s responsibilities (...) and possible courses of action in the Middle East, in building democratic allies, in using intelligence, and much more. (shrink)

Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Ins...

Current guidelines treat palliative sedation to unconsciousness as an effective medical treatment for terminally ill patients who need relief from severe symptoms, yet also restrict its use in ways that are extraordinary for medical treatments. A closer look at the kinds of cases in which palliative sedation is used suggests a way of adjusting the guidelines to resolve this seeming contradiction.

Incapacitated adult patients are commonly divided into two groups for purposes of decision making; those with a surrogate and those without. Respectively, these groups are often referred to as represented and unrepresented, and the relative ethics of decision making between them raises two particular issues. The first issue involves the differential application of the best interests standard between groups. Second is the prevailing notion that representedness and unrepresentedness are categorical phenomena, though it is more aptly understood as a multidimensional and (...) continuous variable based on relational moral authority. This paper examines the nature of representedness as it relates to ethical norms of surrogate decision making. (shrink)

Volume 20, Issue 3, March 2020, Page W1-W2.

Volume 20, Issue 7, July 2020, Page 112-114.

With narrow exception, physicians’ treatment of incapacitated patients requires the consent of health surrogates. Although the decision-making authority of surrogates is appropriately broad, their moral authority is not without limits. Discerning these bounds is particularly germane to ethically complex treatments and has important implications for the welfare of patients, for the professional integrity of clinicians, and, in fact, for the welfare of surrogates. Palliative sedation is one such complex treatment; as such, it provides a valuable model for analyzing the scope (...) of surrogates’ moral authority. Guidelines for palliative sedation that present it as a “last-resort” treatment for severe and intractable suffering yet require surrogate consent in order to offer it are ethically untenable, precisely because the moral limits of surrogate authority have not been considered. (shrink)

Preface : plant theory? -- The first birth of biopower : from plant to animal life in Foucault -- Thinking plants, with Aristotle and Heidegger -- Animal and plant, life and world in Derrida, or, The plant and the sovereign -- From the world to the territory : vegetable life in Deleuze and Guattari, or, What is a rhizome? -- Coda : what difference does it make?

Just as noncapacitated decision making will forever be a feature of clinical medicine, so will the quest for effective advance care planning and serviceable documentation of these preferences. “Re-...

Proportionality, as it pertains to palliative sedation, is the notion that sedation should be induced at the lowest degree effective for symptom control, so that the patient’s consciousness may be preserved. The pursuit of proportionality in palliative sedation is a widely accepted imperative advocated in position statements and guidelines on this treatment. The priority assigned to the pursuit of proportionality, and the extent to which it is relevant for patients who qualify for palliative sedation, have been overstated.

The American Journal of Bioethics, Volume 11, Issue 11, Page 20-21, November 2011.

Background: Previous studies have found lapses in ethical safeguards for subjects of critical-care research. Objective: To assess recently published empiric critical-care research conducted in the United States for the reporting of research protections as they relate to informed consent and surrogate decision-making. Methods: Systematic review of a sample of empiric critical-care research studies published between 2000 and 2004. Results: Of 51 studies reviewed, consent was reported as having been obtained in 44. Assessment of subjects' decision-making capacity was noted in 35% (...) of studies. Assessments of subjects' capacity was less likely to be reported in studies in which researchers accepted consent from either subjects or from third parties, compared to studies with only subjects' consent. Five studies did not report securing Institutional Review Board approval. Conclusion: Lapses in the reporting of critical-care research are prevalent. (shrink)

Since the path-breaking work of Karl Deutsch on security communities and Ernst Haas on European integration, it has been clear that international institutions may create senses of community and belonging beyond the nation state. Put differently, they can socialize. Yet the mechanisms underlying such dynamics have been unclear. This volume explores these mechanisms of international community building, from a resolutely eclectic stand point. Rationalism is thus the social theory of choice for some contributors, while others are more comfortable with social (...) constructivism. This problem-driven perspective and the theoretical bridge building it are the cutting edge in international relations theory. By providing more fined-grained arguments on precisely how international institutions matter, such an approach sheds crucial light on the complex relationship between states and institutions, between rational choice and social constructivism, and, in our case, between Europe and the nation state. (shrink)

Controlled human infection studies (CHIs) involve the intentional infection of human subjects for a scientific aim. Though some past challenge trials have involved serious ethical abuses, in the last few decades, CHIs have had a strong track record of safety. Despite increased attention to the ethics of CHIs during the COVID‐19 pandemic, CHIs remain controversial, and there has been no in‐depth treatment of CHIs through the lens of virtue ethics. In this article, we argue that virtue theory can be helpful (...) for addressing CHIs that present a constellation of controversial, unresolved, and/or under‐regulated ethical issues. We begin with some brief background on virtue ethics. We then substantiate our claim that some CHIs raise a constellation of ethical issues that are unresolved in the ethics literature and/or lack adequate regulatory guidance by demonstrating that CHIs can present indeterminate social value, risks to third parties, limitations on the right to withdraw from research, and questions about the upper limit of allowable risk. We argue that the presence of a virtuous investigator, with virtues such as prudence, compassion, and integrity, is especially important when these unresolved research ethics issues arise, which is the case for certain types of controlled human infection studies. We use the historical example of Walter Reed and the Yellow Fever Commission to illustrate this claim, and we also highlight some contemporary examples. We end by sketching some practical implications of our view, such as ensuring that investigators with experience running CHIs are involved in novel CHI models. (shrink)

This essay traces an astonishing shift in Denny Schmidt’s work, from his emphasis on tragedy and death in 2005’s Lyrical and Ethical Subjects, to an emphasis on the comic possibilities of life in Between Word and Image (2012). Simply put, his earlier book pivots most decisively on language and, as he writes, the ways that language “bears witness to finitude” (2). Between Word and Image, on the other hand, pivots decisively on the image and reveals for us the possibility that (...) “painting is at its heart the presentation of the movement of life” (96). The essay ends with some questions about the specifically political upshot of Schmidt’s work on the relations among aesthetic experience and “life.”. (shrink)

The ‘best interests’ decision making standard is used in clinical care to make necessary health decisions for non-capacitated individuals for whom neither explicit nor inferred wishes are known. It has been also widely acknowledged as a basis for enrolling some non-capacitated adults into clinical research such as emergency, critical care, and dementia research. However, the best interests standard requires that choices provide the highest net benefit of available options, and clinical research rarely meets this criterion. In the context of modern (...) norms of bioethics, the best interests standard rarely supports surrogate consent for research and should not be accepted as a routine provision. (shrink)

Preparations for large-scale disasters have tended to focus on triage schema, stockpiling of materials, and other logistical concerns. Less attention has been given to the myriad of distressing and almost unthinkable ethically charged dilemmas that will emerge at the bedside during a catastrophe, and how they may be best managed. Yet, it is these bedside issues that may limit or thwart the effectiveness of disaster planning, and, therefore, they ought to be carefully considered.

A commentary on “Must We Be Courageous?,” by Ann Hamric, John Arras, and Margaret Mohrmann, and on “Patient-Satisfaction Surveys on a Scale of 0 to 10: Improving Health Care, or Leading It Astray?,” by Alexandra Junewicz and Stuart J. Youngner, bothin the May-June 2015 issue.