This CQ department is dedicated to bringing noted bioethicsts together in order to debate some of the most perplexing contemporary bioethics issues. You are encouraged to contact department editor, D. Micah Hester, UAMS/Humanities, 4301 W. Markham St. #646, Little Rock, AR 72205, with any suggestions for debate topics and interlocutors you would like to see published herein.

This CQ department is dedicated to bringing noted bioethicists together in order to debate some of the most perplexing contemporary bioethics issues. You are encouraged to contact “The Great Debates” department editor, D. Micah Hester, UAMS/Humanities, 4301 W. Markham St., #646, Little Rock, AR 72205, with any suggestions for debate topics and interlocutors you would like to see published herein.

Several months ago, I was walking down the hallway outside our medical school faculty offices and a colleague stopped me to ask a question. He phrased his query in the context of a case that raised ethical issues for him, and he asked me to respond. I obligingly offered my opinion given the details he presented, ending my comments with the phrase, To this he kindly shot back, To be honest, this question caught me off guard. Though his particular dilemma (...) was relatively well-trod territory for many bioethicists, I had done little research on the issue and could not immediately render a response to his latter query. (shrink)

In this paper I use William James's understanding of significance in life to show that for certain patients euthanasia and assisted suicide can be importantly meaningful acts that family, friends, and health care professionals must acknowledge and even, at times, aid in bringing to fruition. Dying with meaning is transformative. It reshapes the lives of others that are left behind, giving to their lives new groundings by engaging them in the meaning of dying for us. For the patient, dying with (...) meaning takes the seemingly formless void in the abyss of death and gives it a significant purpose in the last stages of life itself; it turns potential nothingness into actual significance. To the extent that we outsiders do not help the dying, we condemn terminally ill patients to a meaningless existence until they die. (shrink)

Since the decade of the 1970s, and particularly since the first successful test-tube baby in 1978, the development and use of assisted reproductive technologies have grown exponentially. Would-be parents—including those in so-called traditional male-female marriages, unmarried adults, postmenopausal women, and same-sex partnerships—who just over 20 years ago had no recourse for their fertility issues can now pursue their desires to have children with at least a partial, if not, total, genetic and/or biological relationship. Ovulation-stimulating medications, artificial insemination using the sperm (...) of a husband or unrelated donor, in vitro fertilization with embryo transfer, intracytoplasmic sperm injection, and gamete and zygote intrafallopian transfers are but a few of a host of treatment options ranging in complexity, invasiveness, and expense. And on the horizon are genetic techniques such as cloning—which was once considered “pure” science fiction but in 1997 became what some call an inevitability, with the development of mammalian cloning in the form of the now-famous Dolly the sheep. (shrink)

In April of 2001 I published a brief commentary in the journal Academic Medicine questioning the current character and functioning of the National Residency Matching Program. The purpose of the article was to stimulate a rethinking of process. At 50 years old, the environment through which the match operates has changed, and as such I thought it time to ask ourselves whether or not the match, its algorithm, and, more important, the values it manifests might well need an overhaul.

Berkowitz and Garrett (2020) raise important arguments in favor of consent for apnea testing used in determining death by neurological criteria (DNC); and yet, a fundamental consideration is left u...

Organ procurement presents several ethical concerns (from what constitutes acceptable criteria for death to issues involved in specifically designating to whom an organ can be given), but none is more central than the concern for what are appropriate means for acquiring organs. The following discussion attempts a different perspective on the issue of organ procurement by arguing that, rather than appealing to our charitable consciences or our pocketbooks, relinquishing our organs after death in this day and age is, in fact, (...) obligatory for most people. Each of us is pressed by the growing demand for our organs should we die ?rightly,? and that desperate need has risen to such a level that not to release our organs for transplantation would constitute a serious moral wrong. (shrink)

Introduction to healthcare ethics committees / D. Micah Hester and Toby Schonfeld -- Brief introduction to ethics and ethical theory / D. Micah Hester and Toby Schonfeld -- Ethics committees and the law / Stephen Latham -- Cultural and ...

In Bester’s article (2018) challenging the use of the harm principle and advocating sole reliance on the use of a best interest standard (BIS) in pediatric decision-making, we believe that the auth...

Although there are many different moral arguments concerning the use of Best Interests in neonatal decision-making, there seems in practice a firm commitment to application of the concept. And yet, there is still little reflection given by practitioners about what employing a Best Interest determination means in infant care. The following lays out a comprehensive taxonomy of interest-sources in order to provide for more robust considerations of what constitutes best interests of/for neonates.

This paper attempts to defend pragmatic approaches to bioethics against detractors, showing how particular critics have failed or succeeded. The paper divides bioethics from a pragmatic point of view into three groups. The first group is called "bioethical pragmatism" that will be represented by two book-chapters from the anthology, Pragmatic Bioethics . The second group is called "clinical pragmatism" championed by Fins, Baccetta, and Miller. Finally, a third group, which has roots in the legal tradition, has been called "freestanding pragmatism" (...) and is portrayed by Grey, Posner, and Wolf. Each group has been criticized in journal articles, and, in turn, this paper critiques some of the (mis)understandings put forth by Tollefsen, Jansen, and Arras about the capabilities and status of pragmatism in bioethical discussions. Finally, it concludes with cautionary notes about pragmatic bioethics in hopes that pragmatists will learn from their own insights about the human condition and the discipline of bioethics. (shrink)

Every one of us will die, and the processes we go through will be our own - unique to our own experiences and life stories. End-of-Life Care and Pragmatic Decision Making provides a pragmatic philosophical framework based on a radically empirical attitude toward life and death. D. Micah Hester takes seriously the complexities of experiences and argues that when making end-of-life decisions, healthcare providers ought to pay close attention to the narratives of patients and the communities they inhabit (...) so that their dying processes embody their life stories. He discusses three types of end-of-life patient populations - adults with decision-making capacity, adults without capacity, and children - to show the implications of pragmatic empiricism and the scope of decision making at the end of life for different types of patients. (shrink)

As given, the case presents at least two questions for the ethics consultant to explore: to what extent should Declan’s parent, Karesha, be involved in his health care decisions, and why is...

In response to Anne L. Dalle Ave and David M. Shaw, we agree with their general argument but emphasize a moral risk of HIV disclosure in deceased donation cases: the risk of relational rupture. Because of the importance that close relationships have to our sense of self and our life plans, this kind of rupture can have long-ranging implications for surviving loved ones. Moreover, the now-deceased individual cannot participate in any relational mending. Our analysis reveals the hefty moral costs that (...) disclosure can bring, which should influence what information is given to wouldbe donors and how organ procurement coordinators approach these conversations. (shrink)

Disease and injury creates a break between the individual and the community which compromises the individual's status within the community as well as the integrity of the self as a “product” of social interaction. Our “everyday” activities are called into question since our ability to fulfill obligations and to achieve many of our ends is diminished through the weakening of our bodies. In light of this account of disease, healing is about restoring the individual to a state of vital functioning, (...) and vital functioning entails communal participation. As John Dewey points out, health as “living healthily” can be understood only in context of each patient's pursuits which are always social and communal. But, if living in community with others is the end-in-view for medical encounters, it too must be implicated in the means to that end. A patient who is given the opportunity to participate as a member of the health care community has already begun within the medical encounter itself to live healthily. It follows, then, that we must work to promote new attitudes within health care towards aiding in the effective agency and participation of patients in their healing process – i.e., we must see community as healing. (shrink)

The term community in ethics and bioethics traditionally has been used to designate either a specific kind of moral relationship available to rational agents or, in contrast, the context in which any sense of rational agency can even be understood. I argue that bioethics is better served when both selves and community are expressed through a more processive language that highlights the functional character of such concepts. In particular, I see the turn to processive community in bioethics as a turn (...) towards method, contextualization, and narrative. In clinical practice, such a processive account demands that bioethics concentrate on methods of developing healthy dialogue and deeper understanding from within the problematic situation rather than trying to fix problems using ethical tools developed from outside the present situation. Community, I argue, is in and of the interactive processes of inquiry itself. Such inquiry, such communitying, requires that we engage individual patients in context; it demands more than simply gaining their permission or mere consent; it demands developing a supportive environment for participation. (shrink)

_Offering a new edition of Dewey’s 1916 collection of essays_ This critical edition of John Dewey’s 1916 collection of writings on logic, _Essays in Experimental Logic—_in which Dewey presents his concept of logic as the theory of inquiry and his unique and innovative development of the relationship of inquiry to experience—is the first scholarly reprint of the work in one volume since 1954. _Essays in Experimental Logic, _edited by D. Micah Hester and Robert B. Talisse, uses the authoritative (...) texts from the _Collected Works of John Dewey, 1882–1953_ and includes as well articles from leading journals representing various contemporary schools of philosophy that criticized Dewey’s experimentalism. Culling materials from six volumes of the chronologically arranged _Collected Works_, this single-volume edition of _Essays_ marks a crucial point in Dewey’s intellectual development: one in which Dewey critically engages idealistic and intuitionist theorists and lays the groundwork for his mature theory of inquiry. The text includes a new introduction by renowned Dewey scholar Tom Burke that places _Essays_ in philosophical and historical context. In addition to the original essays, _Essays in Experimental Logic_ also features five critical essays by Dewey’s contemporaries, including Bertrand Russell, Wendell T. Bush, R. F. Alfred Hoernlé, H. T. Costello, and C. S. Peirce. (shrink)

With their target article, “Spheres of Morality…,” Dornberg and Truog (2023) have given us a careful analytic framework for distinguishing moral concerns among different domains involved in medical...

Children like Baby G, born with complex chronic medical conditions that compromise function in the long term, are an increasing presence in tertiary-level neonatal intensive care units. The parents and health-care providers of these children are faced with profoundly difficult decisions. Whether severe congenital anomalies with poor prognosis are diagnosed antenatally or are discovered at the time of birth, the issues are vexing, and the impact decisions will have on everyone in the family is profound. What should such decisions be (...) based upon? What values and principles might guide the decision-making process? What moral justifications allow for pursuing.. (shrink)

The paper by Dupras and Bunnik is a useful addition to the literature on privacy in regards to datasets of human tissue/materials. In particular, the paper addresses import...

This CQ department is dedicated to bringing noted bioethicsts together in order to debate some of the most perplexing contemporary bioethics issues. You are encouraged to contact department editor, D. Micah Hester, UAMS/Humanities, 4301 W. Markham St. #646, Little Rock, AR 72205, with any suggestions for debate topics and interlocutors you would like to see published herein.

The American Journal of Bioethics, Volume 11, Issue 8, Page 44-45, August 2011.

Ross’s argument against the best interest standard (BIS) makes a clear case for the problems of the BIS, and she also notes challenges with such notions as the harm principle. In light of these critiques, Ross champions her longstanding pediatric moral norm for decision making, constrained parental autonomy (CPA). This article argues that while Ross’s critique of the traditional accounts of the BIS is correct, her solution still raises some concerns. As such, I offer the “reasonable interests standard” as a (...) way of addressing what I see as weaknesses in both the BIS and CPA. (shrink)

In the target article, Brendel and Miller (2008) attempt to bring pragmatic insights to bear on research ethics through the approach called freestanding pragmatism that John Arras (2001) brought sq...

Mr. Robinson’s case raises clear concerns regarding whether, when, and even how to disclose unexpected genetic findings when doing genomic research. The American...

What role should age play in the allocation of organs for transplantation? Historically, older patients have not been listed as candidates for transplantation on the assumption that greater benefit could be obtained by favoring younger candidates, raising questions of equity and age discrimination. At the same time, organs offered for donation by the very old are frequently rejected because of concerns about length of viability. We examine a local case that challenges these practices: the liver from an elderly donor was (...) successfully transplanted into an older patient. After exploring some of the potential problems with such a solution, we propose creating a second pool of organs from the very old for transplantation into older candidates, thus expanding the number of organs available, saving additional lives, and including the elderly more visibly in our transplant system. (shrink)