: A familiar criticism of bioethics charges it with being more conceptual than practical—having little application to the "real world." In order to answer its critics and keep its feet on the ground, bioethics must utilize the social sciences more effectively. Empirical research can provide the bridge between conceiving a moral vision of a better world, and actually enacting it.

Across the world, an authoritarian and exclusionary form of populism is gaining political traction. Historically, some populist movements have been democratic and based on a sense of inclusive justice and the common good. But the populism on the rise at present speaks and acts otherwise. It is challenging constitutional democracies. The polarization seen in authoritarian populism goes beyond the familiar left-right political spectrum and generates disturbing forms of extremism, including the so-called alternative right in the United States and similar ethnic (...) and nationalistic political movements in other countries. The field of bioethics will be profoundly affected if authoritarian populism displaces constitutional democracy. But the field has a significant contribution to make to rebuilding the communal and civic foundations upon which constitutional democracy rests. (shrink)

A familiar criticism of bioethics charges it with being more conceptual than practical—having little application to the “real world.” In order to answer its critics and keep its feet on the ground, bioethics must utilize the social sciences more effectively. Empirical research can provide the bridge between conceiving a moral vision of a better world, and actually enacting it.

“There's glory for you!”“I don't know what you mean by ‘glory,’ ” Alice said.Humpty Dumpty smiled contemptuously. “Of course, you dont—till I tell you. I meant ‘there's a nice knock-down argument.’”“But ‘glory’ doesn't mean a ‘nice knock-down argument,” Alice objected.“When I use a word,” Humpty Dumpty said, in rather a scornful tone, “it means just what I choose it to mean—neither more nor less.”“The question is,” said Alice, “whether you can make words mean so many different things.”“The question is,” said (...) Humpty Dumpty, “which is to be master, that's all.”When applied bioethics confronts the topic of futility, the question of who is to be master turns out to be central. Indeed, much of the literature on futility has focused on exactly this question: who gets to define the terms of the debate? Who gets to decide that treatment is “futile” and therefore allowably withheld or withdrawn? (shrink)

“There's glory for you!”“I don't know what you mean by ‘glory,’ ” Alice said.Humpty Dumpty smiled contemptuously. “Of course, you dont—till I tell you. I meant ‘there's a nice knock-down argument.’”“But ‘glory’ doesn't mean a ‘nice knock-down argument,” Alice objected.“When I use a word,” Humpty Dumpty said, in rather a scornful tone, “it means just what I choose it to mean—neither more nor less.”“The question is,” said Alice, “whether you can make words mean so many different things.”“The question is,” said (...) Humpty Dumpty, “which is to be master, that's all.”When applied bioethics confronts the topic of futility, the question of who is to be master turns out to be central. Indeed, much of the literature on futility has focused on exactly this question: who gets to define the terms of the debate? Who gets to decide that treatment is “futile” and therefore allowably withheld or withdrawn? (shrink)

The Institute of Medicine has called on health care leaders to transform their health systems into “learning health care systems,” capable of studying and continuously improving their practices. Learning health care systems commit to carrying out numerous kinds of investigations, ranging from clinical effectiveness studies to quality improvement research and implementation science. There has been progress in realizing the IOM's vision, but also many challenges. One of these challenges has been lingering uncertainty about whether the data collection and monitoring central (...) to learning health care systems is actually research and if so, what kind of ethical oversight it should have. This is not a new question. Yet so far, there has been no foundational analysis of the fit between the existing human subjects protection framework in use in the United States and the new kinds of data collection activities that are being, and increasingly will be, undertaken by learning health care systems. Two companion feature articles in this volume, by a team at Johns Hopkins, fill this void. (shrink)

This paper advances a new paradigm in clinical ethics education that not only emphasizes development of individual cli but also focuses on the institutional context within which health care professionals work. This approach has been applied to the goal of improving the care provided to critically and terminally ill adults. The model has been adopted by about thirty hospitals and nursing homes; additional institutions will soon join the program, entitled Decisions Near the End of Life. Here, we describe the history (...) and rationale for this approach, its goals, pedagogical assumptions, and design. (shrink)

Two papers in this issue address the limits of surrogates’ authority when making life-and-death decisions for dying family members or friends. Using palliative sedation as an example, Jeffrey Berger offers a conceptual argument for bounding surrogate authority. Since freedom from pain is an essential interest, when imminently dying, cognitively incapacitated patients are in duress and their symptoms are not manageable in any other way, clinicians should be free to offer palliative sedation without surrogate consent, although assent should be sought and (...) every effort made to work with surrogates as harmoniously as possible. Ellen Robinson and her colleagues report on the implementation of a policy at Massachusetts General Hospital that supports do-not-resuscitate orders when cardiopulmonary resuscitation is likely to be ineffective or harmful, even if surrogates disagree. The “Doing No Harm” policy at MGH allows for what MGH calls a “medically indicated DNR” and what in some other places is called “a unilateral DNR”—the writing of an order not to provide cardiopulmonary resuscitation, regardless of surrogate disapproval. These kinds of DNR policies have emerged in some hospitals across the country and for much the same reason that Berger provides in his argument regarding palliative sedation. I support the reasoning and the policies in both the Berger and Robinson papers. However, as the authors would most likely agree, the problems they aim to remedy are not simply about the scope of surrogate and professional authority. They are also symptoms of inattention to professional obligations and system failures. (shrink)

As we write, U.S. cities and states with extensive community transmission of Covid‐19 are in harm's way—not only because of the disease itself but also because of prior and current failures to act. During the 2009 influenza pandemic, public health agencies and hospitals developed but never adequately implemented preparedness plans. Focused on efficiency in a competitive market, health systems had few incentives to maintain stockpiles of essential medical equipment. Just‐in‐time economic models resulted in storage of only those supplies needed then. (...) At the same time, global purchasing in search of lower prices reduced the number of U.S. suppliers, with hospitals dependent on foreign companies. There is still a possibility that the pandemic will be manageably bad rather than unmanageably catastrophic in this country. Immediate, powerful, and sustained federal action could make the difference. (shrink)

The ethical dimensions of an aging society are larger than the experience of chronic illness, the moral concerns of health care professionals, or the allocation of health care resources. What, then, is the role of bioethics in an aging society, beyond calling attention to these problems? Once we’ve agreed that aging is morally important and that population‐level aging across wealthy nations raises ethical concerns that cannot be fixed through transhumanism or other appeals to transcend aging and mortality through technology, what (...) is our field’s contribution? We argue that it is time for bioethics to turn toward social justice and problems of injustice and that part of doing so is articulating a concept of good citizenship in an aging society that goes beyond health care relationships. (shrink)

Prompted by a 2019 essay by Jonathan Moreno in the Hastings Center Report, the Center's board of directors undertook a careful examination of the name of its preeiminent award, the Henry Knowles Beecher Award, which has been given to twenty‐nine individuals who have made lifetime contributions to bioethics. citing new research that revealed that Beecher's earlier experimentation on drugs had involved nonconsenting adults, Moreno urged the Center to reevaluate honoring Beecher through this award. After reviewing the relevant published evidence and (...) holding extensive discussions, the board decided to rename the award. We also took the opportunity to reframe the award to emphasize quality of scholarship and impact on thinking, practice, and policy rather than lifetime achievement. The new name—the Founders’ Award of The Hastings Center—reflects our desire to honor not only the Center's cofounders, Daniel Callahan and Willard Gaylin, but also others who helped found the field of bioethics. With great pride, the Center has announced that Patricia King of the Georgetown University Law Center is the 2021 recipient of the Founders’ Award. A distinguished civil rights lawyer, King was instrumental in ensuring justice as one of the three principles of The Belmont Report. (shrink)

Civic education that prepares students for principled civic participation is vital to democracy. Schools face significant challenges, however, as they attempt to educate for democracy in a democracy in crisis. Parents, educators, and policy‐makers disagree about what America's civic future should look like, and hence about what schools should teach. Likewise, hyperpartisanship, mutual mistrust, and the breakdown of democratic norms are perverting the kinds of civic relationships and values that schools want to model and achieve. Nonetheless, there is strong evidence (...) that young people want to be civically engaged and are hungry for more and better civic learning opportunities. Reviving the civic mission of schools is thus a win‐win‐win. Adults want it, youth want it, and democracy needs it. We propose three means by which educators and the public can reconstruct our common purpose and achieve civic innovation to help democracy in crisis: support action civics, strengthen youth leadership outside the classroom, and engage both students and adults with “hard history” and contemporary controversies. (shrink)

A belief that high school students have the cognitive ability to analyze and assess moral choices and should be encouraged to do so but have rarely been helped to do so was the motivation for developing Exploring Bioethics, a six-module curriculum and teacher guide for grades nine through twelve on ethical issues in the life sciences. A multidisciplinary team of bioethicists, science educators, curriculum designers, scientists, and high school biology teachers worked together on the curriculum under a contract between the (...) National Institutes of Health and Education Development Center, a nonprofit research and development organization with a long history of innovation in science education. At the NIH, the Department of Bioethics within the Clinical Center and the Office of Science Education within the Office of the Director guided the project.Our overarching goal for Exploring Bioethics was to introduce students to bioethics as a field of inquiry and to enable them to develop ethical reasoning skills so they could move beyond “gut reactions” to more nuanced positions. (shrink)

This essay summarizes key insights across the essays in the Hastings Center Report's special report “Time to Rebuild: Essays on Trust in Health Care and Science.” These insights concern trust and trustworthiness as distinct concepts, competence as a necessary but not sufficient input to trust, trust as a reciprocal good, trust as an interpersonal as well as structural phenomena, the ethical impermissibility of seeking to win trust without being trustworthy, building and borrowing trust as distinct strategies, and challenges to trustworthiness (...) posed by the contingent nature of science. Together, these insights stand to advance an area of research that we believe has been historically stymied by conceptual confusion and a long‐standing insistence on treating trust as a purely instrumental good. (shrink)

When Dan Callahan and Will Gaylin began The Hastings Center, they saw and sought to study the unseen. They were among the very first to recognize that remarkable advances in biomedical technology were generating questions our society had never before faced. As I take the helm of The Hastings Center forty‐plus years later, it's now my job to be sure we see, name, grapple with, and act on today's questions. Over the next two years, the Center will engage its scholars, (...) our Fellows, other bioethicists, scientists, social science and humanities scholars, health care policy‐makers, and key stakeholders such as journalists, educators, and patients in defining today's set of critical questions. (shrink)

As part of the celebrations of The Hastings Center’s fiftieth anniversary, we are launching an annual prize, The David Roscoe Award for an Early‐Career Scholar’s Essay on Science, Ethics, and Society. The award is named in honor of David Roscoe, an accomplished essayist and recent past chair of the Hastings board. The award is intended to highlight the good scholarship that will take the field of bioethics forward into the next fifty years. It will recognize an early‐career scholar—someone who either (...) is currently pursuing a relevant academic degree or has earned one within the last six years—for a published essay on the social and ethical implications of advances in science and technology. More information about the award, along with online submission forms, is available on The Hastings Center’s website. (shrink)

Here at the Center, we had the privilege of seeing how Dan Callahan lived out his last days and weeks. True to his nature, Dan never stopped thinking or writing. Indeed, his wife Sidney told me that he finished his last essay one day before his death, on July 16th, insisting that she help him get to the computer so he could discuss it with a colleague. “It's my last one,” he told her with his characteristic self‐awareness. Dan also chose (...) the last topic he would focus on: climate change. At a December 2018 board meeting, Dan presented his desire to develop a workshop to explore the ways in which bioethics in general, and The Hastings Center in particular, might be able to make a valuable contribution to addressing the problem of global warming. (shrink)

I met Dan Callahan in 1986—when I came to pitch him. Coming from a sleek office setting near Boston, I was intrigued by The Hastings Center's higgledy‐piggledy environment where so many smart people got to work in a relaxed, inviting atmosphere. I had noticed that the Center was producing a great deal of policy work on a wide range of topics but didn't seem to go further than publishing the highly valuable guidance developed under Dan Callahan's leadership. I ended my (...) pitch, “Look, Dan, where Hastings gets bored and wants to go on to the next topic, my group in Boston gets interested.” To my great pleasure, and despite his skepticism, Dan accepted the pitch. Beyond his generous responsiveness to unproven young people, Dan had many other virtues. For one, he was a boundary crosser. (shrink)

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

Together this August, Hastings Center fellows and staff scholars left their respective studies to look up. Over a three-day period, we engaged with one another, renewing ties with beloved old friends and welcoming new ones. We asked what each other was passionate about. We asked how our field could be better. We shared works-in-progress and imagined how we might work together across institutions, across miles to accomplish things we couldn't do alone.

Bioethics in the twenty‐first century is confronting what one might call “collective‐impact problems.” The ethics guidance and policies that are developed to address these kinds of problems will affect not only individuals but everyone living and future generations too. With many collective‐impact problems, all parties will eventually be worse off if there is a failure to develop solutions to head off damage to the shared environment. However, the effects are not felt equally throughout and across societies; some groups are hit (...) far worse. To address collective‐impact problems, bioethics needs to recalibrate. Our field, and especially American bioethics, should find a better balance between individual rights and the best interests of the group, develop more robust tools for examining structural inequities that damage people's health and well‐being, and study how to engage the public in learning about and shaping ethics guidance for these complex problems. (shrink)

Edmund Pellegrino was a huge figure who leaves a huge legacy. Since his death on June 13, 2013, much has been written to honor his prodigious accomplishments in scholarship, public policy, and institution‐building and to express gratitude for his kindness, humility, and sense of humor. I want to honor his commitment to living a life in which ideas mattered. For him, ideas were not just the stuff by which to build an academic career or rocks to hurl at opposing scholars (...) and policy‐makers. (shrink)

What is bioethics to do when it strives to assess the quality of its research and scholarship and when it needs to justify its work to prospective funders, especially a funder like the National Institutes of Health that privileges empirical discovery? In “A Conceptual Model for the Translation of Bioethics Research and Scholarship,” Debra Mathews and colleagues take an important first step at advancing an answer. The authors describe what they call a translational process, whereby bioethics “outputs” are translated into (...) changes of three types: in thinking, practice, and policy. It goes nearly without saying that bioethics research and scholarship must be held accountable for changes in thinking. What raison d'etre do we have if not to deepen thinking, question assumptions, and encourage ourselves and others to examine hard issues from novel approaches? Assuredly it is hard to assess quality, and even harder to assess specific changes in thinking for which high-quality scholarship may be responsible, but it is a necessary goal and one for which we should strive without reservation. Bioethics should also affect policy and practice. We should document how it does and the extent to which it does as often and as prominently as possible. However, let us be wary of pinning too much on practice and policy changes as the primary way of establishing bioethics’ worth. (shrink)

From accessible and affordable health care to old or new reproductive technologies, human or animal research, and beyond, the justice and well‐being of our society depends on the ability of key groups—such as scientists and health care providers—along with members of the public to identify the key issues, articulate their values and concerns, deliberate openly and respectfully, and together find the most defensible ways forward.The Presidential Commission for the Study of Bioethical Issues and The Hastings Center are committed to improving (...) the ethical literacy of the American public in the domain of bioethics. But what are the best educational practices to spur and support these sorts of societal conversations? And where are the greatest gaps in our collective knowledge of how best to inspire and increase moral understanding, analytical thinking in the moral domain, and professional integrity? (shrink)

This special report is published in commemoration of the fiftieth anniversary of the “Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death,” a landmark document that proposed a new way to define death, with implications that advanced the field of organ transplantation. This remarkable success notwithstanding, the concept has raised lasting questions about what it means to be dead. Is death defined in terms of the biological failure of the organism to (...) maintain integrated functioning? Can death be declared on the basis of severe neurological injury even when biological functions remain intact? Is death essentially a social construct that can be defined in different ways, based on human judgment? These issues, and more, are discussed and debated in this report by leading experts in the field, many of whom have been engaged with this topic for decades. (shrink)

This essay introduces a special report from The Hastings Center entitled Democracy in Crisis: Civic Learning and the Reconstruction of Common Purpose, which grew out of a project supported by the John S. and James L. Knight Foundation. This multiauthored report offers wide‐ranging assessments of increasing polarization and partisanship in American government and politics, and it proposes constructive responses to this in the provision of objective information, institutional reforms in government and the electoral system, and a reexamination of cultural and (...) political values needed if democracy is to function well in a pluralistic and diverse society. The essays in the special report explore the norms of civic learning and institutions, social movements, and communal innovations that can revitalize civic learning in practice. This introductory essay defines and explains the notion of civic learning, which is a lynchpin connecting many of the essays in the report. Civic learning pertains to the ways in which citizens learn about collective social problems and make decisions about them that reflect the duties and responsibilities of citizenship. Such learning can occur in many social settings in everyday life, and it can also be facilitated through participation in the processes of democratic governance on many levels. Civic learning is not doctrinaire and is compatible with a range of public goals and policies. It is an activity that increases what might be called the democratic capability of a people. (shrink)

Ḥeleḳ Rishon, kerekh 1. Teshuvot ha-shayakhot le-Miḳra Midrash ṿe-deʻot ṿe-tsoraf la-hen Sefer Minḥat ḳenaʼot le-R. Aba Mari de-Lunil [Haḳdamah-pereḳ 37] -- Ḥeleḳ Rishon, kerekh 2. Miḳra Midrash ṿe-deʻot Teshuvot ha-shayakhot le-Miḳra Midrash ṿe-deʻot ṿe-tsoraf la-hen Sefer Minḥat ḳenaʼot le-R. Aba Mari de-Lunil [pereḳ 38-pereḳ 127] -- Ḥeleḳ sheni. Teshuvot ha-shayakhot le-Masekhet Berakhot ṿe-Seder Zeraʻim -- Ḥeleḳ shelishi. Teshuvot ha-shayakhot le-Masekhet Shabat ṿe-ʻEruvin.

The complexity of biobank research raises concerns about individuals’ understanding of the information conveyed in the consent process for such research.. We report the results of a qualitative, cognitive interview study with an ethnically, linguistically, and educationally diverse sample of 43 respondents to assess the clarity and utility of a multimedia tool developed for a biobank. Using weighted randomization, respondents were assigned to either view the multimedia tool or read a written consent document . The study illustrates the utility of (...) cognitive interviews for gaining insights from prospective research participants about the clarity of informed consent tools. Findings suggest that a multimedia tool is useful for communicating key messages but should be combined with a written consent document and personal interaction with the study staff. We recommend that the potential value of multimedia tools should be more rigorously tested in a randomized controlled trial. (shrink)

The background to the development of proof theory since 1960 is contained in the article (MATHEMATICS, FOUNDATIONS OF), Vol. 5, pp. 208- 209. Brie y, Hilbert's program (H.P.), inaugurated in the 1920s, aimed to secure the foundations of mathematics by giving nitary consistency proofs of formal systems such as for number theory, analysis and set theory, in which informal mathematics can be represented directly. These systems are based on classical logic and implicitly or explicitly depend on the assumption of \completed (...) in nite" totalities. Consistency of a system S (containing a modicum of elementary number theory) is su cient to ensure that any nitary meaningful statement about the natural numbers which is provable in S is correct under the intended interpretation. Thus, in Hilbert's view, consistency of S would serve to eliminate the \completed in nite" in favor of the \potential in nite" and thus secure the body of mathematics represented in S. Hilbert established the subject of proof theory as a technical part of mathematical logic by means of which his program was to be carried out its methods will be described below. In 1931, Godel's second incompleteness theorem raised a prima facieobstacle to H.P. for the system Z of elementary number theory (also called Peano Arithmetic, and denoted below by PA) since all previously recognized forms of nitary reasoning could be formalized within it. In any case, Hilbert's program could not possibly succeed for any system such as set theory in which all nitary notions and reasoning could unquestionably be formalized. These obstacles led workers in proof theory to modify H.P. in two kinds of ways. The rst was to seek reductions of various formal systems S to more constructive systems S 0. The second was to shift the aims from foundational ones to more mathematical ones. Examples of 1 the former move are the reductions of PA to intuitionistic arithmetic HA, and Gentzen's consistency proof of PA by nitary reasoning coupled with quanti er-free trans nite induction up to the ordinal , TI( 0), both obtained in the 1930s (cf.. (shrink)

We define the notion of a completely determined Borel code in reverse mathematics, and consider the principle $CD - PB$, which states that every completely determined Borel set has the property of Baire. We show that this principle is strictly weaker than $AT{R_0}$. Any ω-model of $CD - PB$ must be closed under hyperarithmetic reduction, but $CD - PB$ is not a theory of hyperarithmetic analysis. We show that whenever $M \subseteq {2^\omega }$ is the second-order part of an ω-model (...) of $CD - PB$, then for every $Z \in M$, there is a $G \in M$ such that G is ${\rm{\Delta }}_1^1$-generic relative to Z. (shrink)

In early March 2020, the March‐April Hastings Center Report was very nearly assembled and contained nothing about Covid‐19, which was still just beginning to make itself publicly known in the United States. Two weeks later, the editorial line‐up was undergoing a remix, and essays that lay out sweeping agendas for the response to the worldwide crisis were in preparation. The central theme in the agenda that Lawrence O. Gostin and colleagues develop is that the pandemic requires a sharp break from (...) usual ethical norms yet simultaneously demands a return to core ethical commitments. A similar theme is sounded by Mildred Z. Solomon and colleagues in a commentary calling for federal actions to keep the health care system functioning. Other essays in the issue take up an assortment of topical issues—including international patient dumping—that were simmering along prior to the pandemic, and the two articles take up foundational questions about the nature of moral reasoning. (shrink)

It is acknowledged that most motifs used in Western art have an iconographic counterpart. It is inferred that the geometric and floral motifs that we encounter in Anatolia are provided by the world meanings such as “ornamentation”, “talisman”, “power” or “strength”, which have a wide place in folk beliefs, rather than creating a meaning by combining with religious images. In this study, it is focused that on the minaret of the Ibrahim Efendi Mosque in Kilis with the Seal of (...) class='Hi'>Solomon motif, which has been used on area of usage in Turkish-Islamic arts, from architectural surfaces to wall paintings, from manuscripts to under-glass paintings. According to the data provided by historical sources, the first work that has existed till now was built by Hacı İbrahim, the son of Hacı Mustafa, one of the residents of Kızılca township. For an unknown reason, a large part of the building was demolished and a second building group was built over time. According to the inscription, the second building group refers to a building group called “the New Mosque”, which was rebuilt in 1831 by Mehmet Pasha, the son of Mehmet Ali Pasha (1769-1849), the Governor of Egypt, who was the Governor of Aleppo. Since only the minaret has existed from the second building group, which consisted of a madrasah-mosque combination, which was demolished over time, this single work is also called “orphan minaret” among the people. In this study, it is emphasized that on the Seal of Solomon motif and the ornamentation of the building, which is especially concentrated in the minaret balcony section. The general acceptance of the six-armed star motif on the pedestal and its usage areas in different works within the Turkish motif tradition were emphasized, and the difference of this motif from the six-armed star, which has a symbolic context in the Jewish faith as Magen David, was determined. The visual data obtained during the survey, archival sources and literature on the structure are based on the documentation method. (shrink)

Big data and artificial intelligence (“AI”) promise to transform virtually all aspects of biomedical research and health care (Matheny et al. 2019), through facilitation of drug development, diagno...

Friedrich Nietzsche is one of the most popular and controversial philosophers of the last 150 years. Narcissistic, idiosyncratic, hyperbolic, irreverent--never has a philosopher been appropriated, deconstructed, and scrutinized by such a disparate array of groups, movements, and schools of thought. Adored by many for his passionate ideas and iconoclastic style, he is also vilified for his lack of rigor, apparent cruelty, and disdain for moral decency. In Living with Nietzsche, Solomon suggests that we read Nietzsche from a very different (...) point of view, as a provocative writer who means to transform the way we view our lives. This means taking Nietzsche personally. Rather than focus on the "true" Nietzsche or trying to determine "what Nietzsche really meant" by his seemingly random and often contradictory pronouncements about "the Big Questions" of philosophy, Solomon reminds us that Nietzsche is not a philosopher of abstract ideas but rather of the dazzling personal insight, the provocative challenge, the incisive personal probe. He does not try to reveal the eternal verities but he does powerfully affect his readers, goading them to see themselves in new and different ways. It is Nietzsche's compelling invitation to self-scrutiny that fascinates us, engages us, and guides us to a "rich inner life." Ultimately, Solomon argues, Nietzsche is an example as well as a promulgator of "passionate inwardness," a life distinguished by its rich passions, exquisite taste, and a sense of personal elegance and excellence. (shrink)