Generative artificial intelligence (AI) has the potential to transform many aspects of scholarly publishing. Authors, peer reviewers, and editors might use AI in a variety of ways, and those uses might augment their existing work or might instead be intended to replace it. We are editors of bioethics and humanities journals who have been contemplating the implications of this ongoing transformation. We believe that generative AI may pose a threat to the goals that animate our work but could also be (...) valuable for achieving those goals. In the interests of fostering a wider conversation about how generative AI may be used, we have developed a preliminary set of recommendations for its use in scholarly publishing. We hope that the recommendations and rationales set out here will help the scholarly community navigate toward a deeper understanding of the strengths, limits, and challenges of AI for responsible scholarly work. (shrink)

Both articles in the November‐December 2021 issue of the Hastings Center Report reflect bioethics’ growing interest in questions of justice, or more generally, questions of how collective interests constrain individual interests. Hugh Desmond argues that human enhancement should be reconsidered in light of developments in the field of human evolution. Contemporary understandings in this area lead, he argues, to a new way of thinking about the ethics of enhancement—an approach that replaces personal autonomy with group benefit as the primary criterion (...) for deciding what enhancements are acceptable. In the second article, Johannes Kniess considers the many attempts within bioethics to draw on John Rawls's work to discuss health care access and social determinants of health, and he comes across as moderately optimistic that Rawls's theory of justice has ongoing relevance. (shrink)

How strong is the argument for requiring public deliberation by very large publics—at national or even global levels—before moving forward with efforts to use gene editing on wild populations of plants or animals? Should there be a general moratorium on any such efforts until such broad public deliberation has been successfully carried out? This article works toward recommendations about the need for and general framing of broad public deliberation. It finds that broad public deliberation is highly desirable but not flatly (...) necessary before moving forward with any local cases of gene editing in the wild. It also finds that broad public deliberation would be most helpful in generating very general guidance and is unlikely to be appropriate for specific cases. Broad public deliberation is most helpful for cases that involve higher levels of uncertainty and moral ambiguity, but separating out a distinct class of cases for deliberation is not yet possible. (shrink)

Can we make wise policy decisions about still‐emerging technologies—decisions that are grounded in facts yet anticipate unknowns and promote the public's preferences and values? There is a widespread feeling that we should try. There also seems to be widespread agreement that the central element in wise decisions is the assessment of benefits and costs, understood as a process that consists, at least in part, in measuring, tallying, and comparing how different outcomes would affect the public interest. But how benefits and (...) costs are best weighed when making decisions about whether to move forward with an emerging technology is not clear. Many commentators feel that the weighing is often inadequate or inappropriate. Those who argue for a “precautionary” approach to the weighing do so precisely because they feel the need for a restraint on the dominant decision‐making tools and processes for assessing outcomes.This Hastings Center special report examines those tools and processes, taking the method known as cost‐benefit analysis as a starting point. In U.S. governance, CBA, sometimes informed by risk assessment, is the most widely used and extensively studied method, and authoritative reports on genetic and reproductive technologies often use language suggestive of cost‐benefit analysis. There is also a long‐running debate about the role of values in CBA and other formal impact assessment mechanisms—and about how those mechanisms compare to the precautionary principle. The guiding idea in the report is to engage in a close examination of the strengths and limits of CBA for ensuring that emerging technologies are used in ways that square with the public's values, drawing on applications of synthetic biology to illustrate and sharpen the analysis and then considering corrections to CBA and some alternative methodologies that handle values differently. (shrink)

The emergence of de‐extinction is a study in technological optimism. What has already been accomplished in recovering ancient genomes, recreating them, and reproducing animals with engineered genomes is amazing but also has a long ways to go to achieve “de‐extinction” as most people would understand that term. Still, with some caveats in place, creating a functional replacement for an extinct species may sometimes be doable, and given the right goals, might sometimes make sense. The International Union for Conservation of Nature (...) guidelines for de‐extinction do a reasonable job of keeping the caveats in place and clarifying the goals. In fact, given the right caveats about what de‐extinction can accomplish, we should pay a lot of attention to the technology and should think carefully about the goals. Not only has the technology been advancing, but our environmental standards have been getting looser and more flexible, providing less guidance for implementing the technology. The guiding ideals for conservation are often explained as a choice between John Muir, founder of The Sierra Club, and Gifford Pinchot, who helped create the U.S. Forest Service. Muir argued for preserving some places in the world in their natural state because of their great value and beauty. Pinchot, by contrast, was bluntly utilitarian. He argued for trying to keep some natural places more or less undamaged so that we could use them later. There has long been dissatisfaction with this choice, and in the last couple of decades, a number of prominent voices have proposed a “gardening ethic” as a new standard that combines elements of Muir and Pinchot. A gardening ethic is supposed to both celebrate the land and declare that it must now be managed. But what would good gardening mean when it comes to de‐extinction? (shrink)

Advancing neuroscience is one of many topics that pose a challenge often called “the alignment problem”—the challenge, that is, of assuring that science policy is responsive to and in some sense squares with the public's values. This issue of the Hastings Center Report launches a series of scholarly essays and articles on the ethical and social issues raised by this vast body of medical research and bench science. The series, which will run under the banner “Neuroscience and Society,” is supported (...) by the Dana Foundation and seeks to promote deliberative public engagement, broadly understood, about neuroscience. As a social goal, deliberative public engagement is both ubiquitous and elusive—called for everywhere yet difficult to undertake at a national level on a complex scientific topic. To be meaningful, deliberative public engagement must occur in many locations in a society and be carried forward by many actors. Scholarly writing might contribute in several ways. (shrink)

Generative artificial intelligence (AI) has the potential to transform many aspects of scholarly publishing. Authors, peer reviewers, and editors might use AI in a variety of ways, and those uses might augment their existing work or might instead be intended to replace it. We are editors of bioethics and humanities journals who have been contemplating the implications of this ongoing transformation. We believe that generative AI may pose a threat to the goals that animate our work but could also be (...) valuable for achieving those goals. In the interests of fostering a wider conversation about how generative AI may be used, we have developed a preliminary set of recommendations for its use in scholarly publishing. We hope that the recommendations and rationales set out here will help the scholarly community navigate toward a deeper understanding of the strengths, limits, and challenges of AI for responsible scholarly work. (shrink)

The new generative artificial intelligence (AI) tools, and especially the large language models (LLMs) of which ChatGPT is the most prominent example, have the potential to transform many aspects o...

In the lead article in the May‐June 2019 issue of the Hastings Center Report, Aaron Wightman and coauthors consider the guiding principles for making decisions about life‐sustaining treatment for children who have profound cognitive impairments. They argue that the usual standard, which asks decision‐makers to consider what will be in the child's best interests, cannot provide sufficient guidance. Discussing this problem in HCR thirty‐five years ago, the philosopher John Arras proposed addressing it by means of a “relational potential standard,” according (...) to which decisions about providing life‐sustaining treatment to a child should depend in part on whether the child has the capacity to form human relationships. Wightman et al. build on Arras's work, but where Arras had suggested that the capacity to form relationships could be gauged by examining the child's cognitive capabilities, the authors suggest that the medical team should lean heavily on the parents’ views. (shrink)

The November–December issue of the Hastings Center Report features a set of essays on the ethics of writing stories of patient care. The Report regularly features such stories, but some ways of telling them would be plainly unacceptable, and some in bioethics have suggested that the bar for acceptability is very high. Tod Chambers takes that position in this essay set. Drawing on the work of the literary theorist Mikhail Bakhtin, he proposes that case studies should be “polyphonic”—meaning that they (...) contain “a diversity of voices that are unmediated and distinct.” In effect, he calls for a kind of coauthoring of stories about patients. In a second essay, Arthur Frank also calls for including the patient’s voice, but he builds on Bakhtin’s call for “dialogic” storytelling, in which the author seeks to represent the characters in the story as having their own voices and their own lives: “they can talk back.” A third essay, by Philip Rosoff, is concerned about the problem of harm and patient anonymity, which in the contemporary media environment has become harder to address. (shrink)

In some sense, argues Christopher Meyers in the lead article in this, the July‐August 2021, issue of the Hastings Center Report, to be a good ethicist is to be an activist. The question for the ethicist, and for Meyers, is about how hard and far to push: how much personal risk to shoulder, how much to tick off colleagues, how much institutional disruption to create, how much to look like an angry protester. Meyers argues for aiming at the middle, in (...) two senses. In a time of anger and activism about relentless, pervasive, overwhelming wrongs, the question of balance is increasingly front of mind. A set of commentaries we solicited both welcome Meyers's call for activism and push for more. (shrink)

The emerging phenomenon of genetic paternity testing shows how good science and useful social reform can run off the rails. Genetic paternity testing enables us to sort out, in a transparent and decisive way, the age-old but traditionally never-quite-answerable question of whether a child is genetically related to the husband of the child's mother. Given the impossibility of settling this question for certain, British and American law has long held that a biological relationship must almost always be assumed to exist. (...) According to what is known as the “marital presumption” or “presumption of legitimacy,” a child born to a woman within a marital relationship is assumed to be the biological child of the woman's husband unless he was absent, impotent, or sterile. In other words, if paternity was not a physical impossibility for the husband, there was a nearly irrebuttable presumption that he was the father of the child. The husband was locked into the role of fatherhood. a. (shrink)

The lead article in this issue of the Hastings Center Report explores the ideas underpinning the Precision Medicine Initiative, the effort announced by President Obama in 2015 to promote the development of treatments adjusted to genetic and other variations. Authors Maya Sabatello and Paul Appelbaum hold that the effort works by appealing to a sense of collective identity and shared commitment—an understanding that they call the “PMI nation.” But what are the moral implications of this idea? Sabatello and Appelbaum's question (...) about the impact of an imagined community is an unusual way of exploring a set of values questions. In the second article, Johann Brännmark defends what is, at least in bioethics, an unusual philosophical framework for moral values. Brännmark starts by calling attention to large, never-quite-solved problems with the field's going way of understanding personhood and autonomy, and then argues that the body of tradition, law, and international governance known as the human-rights framework offers a solution to those problems. And a supplement to this issue offers a set of essays on a topic outside the usual range for bioethics: the prospect of “de-extinction”—that is, of using genetic and reproductive technologies to construct simulacra of extinct animals that might eventually be introduced into the wild. (shrink)

This issue of the Hastings Center Report features three articles exploring aspects of decision-making for others. In the first two, the focus is on the limits of surrogate decision-makers’ authority when the surrogates’ judgments about a patient's treatment conflict with the physicians’. If a physician decides that a patient will not benefit from CPR, for example, but the patient's surrogate insists on it, is the physician obliged to proceed with the procedure? Or can the physician, pointing to a duty to (...) provide good care to the patient and not to cause the patient to suffer, get a do-not-resuscitate order for the patient—even in the face of the surrogate's objections? These are the questions that animate the first article, in which a group of authors report on a policy implemented at Massachusetts General Hospital to help doctors who face this dilemma. The second article, by physician Jeffrey Berger, flips the questions. If a physician decides that a patient's intractable suffering requires palliative sedation, may the surrogate prevent it anyway? Or can the physician, pointing to a duty to alleviate the suffering, administer palliative sedation even in the face of the surrogate's objections? Such circumstances, says Berger, show the need for conceptual work delineating the limits of surrogates’ authority and practical work on mechanisms for doing so—protecting patients and giving physicians a clear route to follow. (shrink)

A majority opinion seems to have emerged in scholarly analysis of the assortment of technologies that have been given the label “synthetic biology.” According to this view, society should allow the technology to proceed and even provide it some financial support, while monitor­ing its progress and attempting to ensure that the development leads to good outcomes. The near‐consensus is captured by the U.S. Presidential Commission for the Study of Bioethical Issues in its report New Directions: The Ethics of Synthetic Biology (...) and Emerging Technologies, which arguably marked the end of a preliminary round of analysis about the ethical and policy questions raised by synthetic bi­ology. Like a number of other, earlier documents issued by various groups around the world, the re­port called attention to questions about how the technology will be used; whether it might be mis­used; what sorts of accidents might happen along the way; the economic, environmental, and social impacts of the eventual applications; whether the very idea of “synthetic biology” should be trou­bling; and how the debate over all of these ques­tions will be conducted. Also like most similar documents, however, while it called for careful monitoring and oversight of technology, it did not recommend any significant new constraints on its development and use. The commission's stance was that it would be “imprudent either to declare a moratorium on synthetic biology until all risks can be determined and mitigated, or to simply ‘let science rip,’ regardless of the likely risks.”In this report, we will take stock of the current consensus, comment on some of the major points of disagreement, and identify the next steps for the debate. In part I, we offer a brief overview of the research and applications commonly grouped together under the heading of synthetic biology, partly in order to set the stage for the rest of the discussion and partly because we want to highlight some conceptual problems that attend the very la­bel given this field. In parts II, III, and IV, we take up, respectively, three broad classes of concerns that arise in the context of synthetic biology: con­cerns about the intrinsic or inherent value of do­ing synthetic biology, concerns about the concrete harms and benefits of doing synthetic biology, and concerns about justice. Addressing these concerns requires a method for bringing the public's values to bear on policy‐making concerning emerging biotechnologies; in part V, we discuss the chal­lenges in developing such a method. (shrink)

The new generative artificial intelligence (AI) tools, and especially the large language models (LLMs) of which ChatGPT is the most prominent example, have the potential to transform many aspects o...

The Covid‐19 pandemic has highlighted connections between health and social structural phenomena that have long been recognized in bioethics but have never really been front and center—not just access to health care, but fundamental conditions of living that affect public health, from income inequality to political and environmental conditions. In March, as the pandemic spread globally, the field's traditional focus on health care and health policy, medical research, and biotechnology no longer seemed enough. The adequacy of bioethics seemed even less (...) certain after the killing of George Floyd, whose homicide showed in an especially agonizing way how social institutions are in effect (and often intentionally) designed to make the lives of black people go poorly and end early. Whether bioethics needs to be expanded, redirected, and even reconceived is at the heart of the May‐June 2020 issue of the Hastings Center Report, which is devoted to questions provoked by and lessons emerging during this pandemic. (shrink)

The lead article in this January‐February 2021 issue—the first of the Hastings Center Report's fiftieth year of publication—does not set out to change medicine. It tries instead to understand it. In “A Heart without Life: Artificial Organs and the Lived Body,” Mary Jean Walker draws on work in phenomenology and on empirical research with people who have received artificial heart devices to argue that such devices may have two very different effects on how a patient experiences the body and the (...) self. Several other pieces in this issue address the ongoing slew of patient care and health policy problems surrounding the Covid‐19 pandemic, and a special report titled Democracy in Crisis: Civic Learning and the Reconstruction of Common Purpose considers the requirements for public involvement in policy‐making about bioethical issues. (shrink)

Bioethicists have sometimes regarded the opioid epidemic as a problem with obvious answers and thus no need for the field's conceptual analysis. Yet, as three essays in the July‐August 2020 issue of the Hastings Center Report demonstrate, the opioid crisis contains a knot of distinctions and puzzles to be sorted out. Travis N. Rieder examines, for example, what is fundamentally driving the crisis—access to the drugs or large societal problems such as poverty and joblessness. The role of choice in addiction, (...) the effects of moral condemnation on approaches to addiction, and what treatment should look like are among the puzzles Hanna Pickard explores, while Daniel S. Goldberg focuses on the common and harmful conflation of the public health problems of substance misuse and pain. These philosophical and bioethical questions point in widely different directions, lying both inside and outside bioethics. They point toward systemic societal factors that determine health and well‐being yet have seemed outside bioethics' largely clinical boundaries. And they point toward a deeper look at the very idea of autonomy—an examination of a topic clearly within bioethics yet occurring at the fringes of its usual constructs. (shrink)

The lead article in this, the September‐October 2020, issue of the Hastings Center Report considers the use of metaphors in communications with clinicians and patients.

A competent person can avoid the onset of dementia by refusing life‐sustaining medical care and by voluntarily stopping eating and drinking, bringing life to an end well before any health crisis. A competent person can also try to limit the duration of dementia by drafting an advance directive that sets bounds on the life‐sustaining care, including artificial nutrition and hydration, that medical caregivers can provide when the person no longer has the capacity to make her own medical decisions. But between (...) these two strategies there can lie a significant gap. A person could live with moderate to severe dementia for a considerable time, no longer able to voluntarily stop eating and drinking yet also not yet requiring the life‐sustaining care forbidden by advance directive.This gap has been much discussed in recent years in the Hastings Center Report. Several years ago (in the May‐June 2014 issue), Paul Menzel and M. Colette Chandler‐Cramer argued for what they described as a moderate correction to the dominant view that food and water should always be offered to a patient with dementia if the patient expresses a desire to eat and drink. The problem is taken up again by the legal scholar Norman L. Cantor in this issue (July‐August 2018), and Cantor, too, tries to find a moderate alternative. (shrink)

What are the boundaries of bioethics? Where does bioethics give way to other kinds of ethics—organizational ethics, environmental ethics, social ethics, or just ethics? According to one commonly cited account of the origin of bioethics, the field always had a relatively broad remit; it was supposed to be about the ethics of the life sciences in general. In the early days of bioethics, however, the topic that seemed most in need of critical attention was the encounter between experts in medicine (...) and the laity—doctors or medical researchers on the one hand and patients or medical research subjects on the other. Even given the narrow focal point, however, bioethics very naturally expanded.Much of the September‐October 2018 issue of the Hastings Center Report either argues or assumes that bioethics extends well beyond into social ethics. A special report published as a supplement to this issue pushes the point explicitly. (shrink)

The March–April issue of the Hastings Center Report offers another in a series of articles over the last few years on the structure and the ethics of surrogate decision‐making. Here, Daniel Brudney addresses how to help the surrogate deal with a treatment decision. A core insight he offers is that the structure of the surrogate’s decision has been misunderstood and the misunderstanding makes the task yet harder. As usually understood, the surrogate is supposed to be guided by the question, what (...) would the patient choose, if the patient were making the choice herself? Brudney argues that this conception is impossible, and that the surrogate’s task is instead to consider the patient’s best interests, as illuminated in part by the patient’s expressed values and past choices. This understanding leads, he argues, to a different guiding question: what could the patient choose, given her values? (shrink)

The November‐December 2018 issue of the Hastings Center Report celebrates two anniversaries. In a supplement to the issue, the fifty‐year‐old debate about what “dead” means—a debate launched in 1968 by the publication of the Harvard report on brain death—is dissected and reinvigorated in a set of essays assembled by Robert Truog, of Harvard Medical School's Center for Bioethics, and The Hastings Center's Nancy Berlinger, Rachel Zacharias, and Mildred Solomon. Inside the regular issue, a set of essays celebrates the two‐hundredth anniversary (...) of the publication of Frankenstein; or, The Modern Prometheus, the novel about death, dissection, and reinvigoration and a touchstone for much commentary about emerging biotechnologies. Elsewhere in the issue are contrasting perspectives on physician‐assisted death, and in the lead article, Danielle Wenner explores the requirement, often noted but recently challenged, that medical research must have “social value” to be worth conducting. (shrink)

Two articles in the September–October 2022 issue of the Hastings Center Report discuss health‐related reasons that people might have to actively bring their lives to an end. In one, Brent Kious considers the situation of a person who, because of illness, becomes a burden on loved ones. A person in such a situation might prefer to die, and Kious argues that, while there is no obligation to hasten one's death, the choice to do so could sometimes be reasonable. In a (...) second article, Henri Wijsbek and Thomas Nys discuss a case in the Netherlands in which a woman with severe dementia was euthanized at a point when her advance euthanasia directive did not align with what she said, when asked, about death. Wijsbek and Nys defend the authority of her advance directive against a range of objections.In a third article, Henry Silverman and Patrick Odonkor, physicians at the University of Maryland Medical Center, where the first pig‐to‐human heart transplantation was performed in early 2022, develop recommendations for clinical trials of porcine heart transplantation. And an essay in the issue criticizes the allocation recommendations developed for Covid‐19 vaccines by the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. (shrink)

Good ethics start with good facts, as Tom Murray, past president of Hastings, often said when he was here, and that alone might be enough to declare that fields like genetic science and synthetic biology warrant their own subfields of ethics—“genethics” and “synthethics.” Perhaps getting clear on how genetic science might be used to improve human health requires such deep immersion in the genetic science that those studying the science's ethical implications are in effect in a subfield of ethics. A (...) further issue is whether the ethical questions about the scientific facts in a nascent field are new. (shrink)

In the current issue of The New Atlantis, Daniel Sarewitz, professor of science and society at Arizona State University, argues that science is broken because it is managed and judged by scientists themselves, operating under Vannevar Bush's famous 1945 declaration that scientific progress depends on the “free play of free intellects … dictated by their curiosity.” With that scientific agenda, society ends up with a lot of unnecessary, uncoordinated, and unproductive research. To save science, holds Sarewitz, we need to put (...) it in the hands of people who are looking for practical solutions to specific problems. In one article in this issue of the Hastings Center Report, Kirstin Borgerson poses a question in this same conceptual space: are there too many clinical trials? Other pieces in the issue cover a mix of topics: the lead article addresses some of the challenges that will have to be faced as “artificial organs” become available, a third article looks at how crowdfunding sites like GoFundMe can be used to make public appeals for medical funding, and a special report found in a supplement to the issue offers a round of analysis and recommendations about the provision of medical care to professional football players. (shrink)

This issue of the Hastings Center Report coincides with the annual conference of the American Society for Bioethics and Humanities, whose theme this year is “Where do we stand?” The issue addresses that theme with the article by Debra Mathews and colleagues and the set of brief response essays that follow it. Mathews et al., drawing on work carried out by the Association of Bioethics Program Directors, pose questions about how to understand and evaluate the worth of bioethics research. Those (...) questions require them to think very broadly about what bioethics is, in the first place, and how it is related to medicine, health policy, science, and society generally. In short, they are thinking at the highest level about the question, where do we stand? (shrink)

Hastings Center Report, Volume 52, Issue 5, Page 2-2, September–October 2022.

Hastings Center Report, Volume 52, Issue 2, Page 2-2, March‐April 2022.

Hastings Center Report, Volume 52, Issue 3, Page 2-2, May–June 2022.

The lead article in the Hastings Center Report's November‐December 2020 issue reconsiders the rationale for requiring that patients have a prescription from a physician to obtain a drug. Madison Kilbride, Steve Joffe, and Holly Fernandez Lynch conclude that growing respect for patient autonomy should lead to a new default for drug access: drugs should be available over the counter unless there are special concerns about harms to third parties or about patients' ability to make decisions for themselves. This conclusion would (...) be a substantial reorientation of drug policy in the United States. Bioethics at a societal level is a theme in the second article, “The Social Risks of Science,” and throughout the issue. (shrink)

Hastings Center Report, Volume 51, Issue 5, Page 2-2, September‐October 2021.

Moral philosophy has its version of physics’ search for a unified theory. Physicists have often thought it unseemly that the four fundamental forces governing how particles interact with each other cannot be reduced to one. Moral philosophers have often tried to unify the fundamental values governing how moral agents interact with each other. Bioethicists have mostly given up on complete unification and settled for drawing on multiple fundamental values. They see unification as a metatheoretical and unproductive project, too much the (...) stuff of physics and not enough like engineering. Still, there's been a long-running debate within bioethics about how many and which values to keep in the toolkit. Can autonomy, beneficence, and justice, fashioned into “principles,” do all of the essential work? Or are “dignity” and “solidarity,” for example, also sometimes necessary? The lead article in this issue of the Hastings Center Report argues for including solidarity in the kit. (shrink)

We are living in what is widely considered the sixth major extinction. Most ecologists believe that biodiversity is disappearing at an alarming rate, with up to 150 species going extinct per day according to scientists working with the United Nations Convention on Biological Diversity. Part of the reason the loss signified by biological extinction feels painful is that it seems irremediable. These creatures are gone, and there's nothing to be done about it. In recent years, however, the possibility has been (...) broached that, just possibly, something can be done, in at least some cases. Human ingenuity, a contributing factor in the extinction crisis, might achieve their “de‐extinction”—in at least some cases, and with sometimes significant qualifications about whether the original species had been “recreated” and whether it could resume its original place in the environment. De‐extinction is an entry point into a larger set of questions about how biotechnological tools can support, coexist with, or undermine the goals of conservation and about the very meaning of conservation. Are we beings in control of the world or beings who prosper by accommodating ourselves to webs of symbiotic interdependencies? Are we creators or creatures, or both—and if both, then how can we achieve the balance between them that might be called humility? The interplay of perfecting and accommodating is not unique to human beings—perhaps it characterizes all forms of life on Earth—but with humans, these modes of being are distinctive, and our technology greatly expands their scale and effects. It is such questions that the ten essays in this special report explore. (shrink)

I once heard John Arras, who was one of bioethics’ bright lights and, toward the end of his life, a member of the Presidential Commission for the Study of Bioethical Issues, remark that it is hard for an ethics commission not to “do paint‐by‐numbers ethics.” What I think Arras had in mind is an approach that, in the set of essays that make up this special report, Rebecca Dresser describes as a listing of “general, often relatively uncontroversial” moral positions to (...) support largely procedural recommendations. Arras was calling attention to one of the challenges and sometimes frustrations of commission thinking. It is a recurring topic in this special report, Goals and Practices of Public Bioethics, which features a series of reflections about how national bioethics commissions around the world have contributed to public understanding and public policy about bioethical issues. Both the topic and the authors are drawn from the final two public meetings of the PCSBI, which was the most recent U.S. example of a national bioethics commission and whose winding down created an occasion for pondering the different forms and functions of bioethics commissions. (shrink)

I was recently asked to report on editorial trends in the Hastings Center Report, past and future. What I reported is that HCR has been going in two seemingly contrasting directions. One has to do with moral decision‐making in clinical ethics—the core theme in bioethics for fifty years, but still developing. A second editorial trend is treatment of larger social and political issues that bear on health, such as public health interventions and access to health care. I could also have (...) noted a continuing stream of pieces on emerging technologies, from whole‐genome screening for newborns to artificial intelligence in clinical diagnoses to the so‐called de‐extinction of extinct animals and plants through various genetic and reproductive tricks. This January‐February 2019 issue of HCR reflects all these trends. (shrink)

In a 2015 Hastings Center Report essay, Robert Truog and his coauthors argued that the clinical ethics portion of medical education should cast both a wider and a finer net than is sometimes realized. Many of the morally important moments in patient care are missed if we teach only general moral principles, they held; we also need to give attention to an indefinite stream of “microethical” decisions in everyday clinical practice. In the current issue, Truog plays out a similar theme (...) as he discusses the moral significance of touching a patient and asks how artificial intelligence and other emerging technologies may change this ancient part of the physician‐patient relationship. And one of the articles in this issue examines the significance of clinicians’ relationships with other clinicians. Donna Chen and colleagues propose, in effect, that “teamwork” has become part of the ethics of everyday clinical practice—a new addition to what Larry Churchill and David Schenck called the “healing skills.”. (shrink)

I was recently asked to report on editorial trends in the Hastings Center Report, past and future. What I reported is that HCR has been going in two seemingly contrasting directions. One has to do with moral decision‐making in clinical ethics—the core theme in bioethics for fifty years, but still developing. A second editorial trend is treatment of larger social and political issues that bear on health, such as public health interventions and access to health care. I could also have (...) noted a continuing stream of pieces on emerging technologies, from whole‐genome screening for newborns to artificial intelligence in clinical diagnoses to the so‐called de‐extinction of extinct animals and plants through various genetic and reproductive tricks. This January‐February 2019 issue of HCR reflects all these trends. (shrink)

This issue of the Hastings Center Report features a couple of interesting takes on the governance challenges of emerging technologies. In an essay on the National Academies of Science, Engineering, and Medicine report published this February on human germ-line gene editing, Eric Juengst, a philosopher at the University of North Carolina, argues that the NASEM committee did not manage to rethink the rules. Juengst reaches what he calls an “eccentric conclusion”: “The committee's 2017 consensus report has been widely interpreted as (...) ‘opening the door’ to inheritable human genetic modification and holding a line against enhancement interventions. But on a close reading it does neither.” In the column Policy and Politics, Sarah Chan, a chancellor's fellow at the University of Edinburgh, discusses the emerging science of “organoids,” “embryoids,” and “synthetic human entities with embryo-like features” and calls for a sustained effort to rethink the rules for embryo research. (shrink)

Two articles in the March‐April 2021 issue of the Hastings Center Report consider alterations to traditional informed consent. In “The Consent Continuum: A New Model of Consent, Assent, and Nondissent for Primary Care,” Marc Tunzi and colleagues argue that, in primary care settings, patient consent should be understood as taking a range of forms depending on the procedure, the patient, and the patient‐care context. Traditional informed consent is at the ceremonious end; for many things done in these settings, the authors (...) assert, assent or even nondissent is fine. In the lead article, health policy scholars Stephanie Morain and Emily Largent consider another continuum for informed consent, this one occurring with pragmatic research, at the intersection of clinical care with research. (shrink)