Issues concerning patients' rights are at the center of bioethics, but the political basis for these rights has rarely been examined. In Bioethics in a Liberal Society: The Political Framework of Bioethics Decision Making , Thomas May offers a compelling analysis of how the political context of liberal constitutional democracy shapes the rights and obligations of both patients and health care professionals. May focuses on how a key feature of liberal society -- namely, an individual's right to make independent (...) decisions -- has an impact on the most important relational facets of health care, such as patients' autonomy and professionals' rights of conscience. Although a liberal political framework protects individual judgments, May asserts that this right is based on the assumption of an individual's competency to make sound decisions. May uses case studies to examine society's approach to medical decision making when, for reasons ranging from age to severe mental disorder, a person lacks sufficient competency to make independent and fully informed choices. To protect the autonomy of these vulnerable patients, May emphasizes the need for health care ethics committees and ethics consultants to help guide the decision-making process in clinical settings. Bioethics in a Liberal Society is essential reading for all those interested in understanding how bioethics is practiced within our society. (shrink)

National history has once again become a battlefield. In internal political conflicts, which are fought on the terrain of popular culture, museums, schoolbooks, and memorial politics, it has taken on a newly important and contested role. Irrespective of national specifics, the narratives of new nationalism are quite similar everywhere. National history is said to stretch back many centuries, expressesing the historical continuity of a homogeneous people and its timeless character. This people struggles for independence, guided by towering leaders and inspired (...) by the sacrifice of martyrs. Unlike earlier forms of nationalism, the main enemies are no longer neighbouring states, but international and supranational institutions. To use national history as an integrative tool, new nationalists claim that the media and school history curricula should not contest or question the nation and its great historical deeds, as doubts threaten to weaken and dishonour the nation. This book offers a broad international overview of the rhetoric, contents, and contexts of the rise of these renewed national historical narratives, and of how professional historians have reacted to these phenomena. The contributions focus on a wide range of representative nations from around all over the globe. (shrink)

The study of anarchism as a philosophical, political, and social movement has burgeoned both in the academy and in the global activist community in recent years. Taking advantage of this boom in anarchist scholarship, Nathan J. Jun and Shane Wahl have compiled twenty-six cutting-edge essays on this timely topic in New Perspectives on Anarchism.

Volume 20, Issue 3, March 2020, Page 32-34.

Many adoptees face a number of challenges relating to separation from biological parents during the adoption process, including issues concerning identity, intimacy, attachment, and trust, as well as language and other cultural challenges. One common health challenge faced by adoptees involves lack of access to genetic-relative family health history. Lack of GRFHx represents a disadvantage due to a reduced capacity to identify diseases and recommend appropriate screening for conditions for which the adopted person may be at increased risk. In this (...) article, we draw out common features of traditionally understood “health disparities” in order to identify analogous features in the context of adoptees’ lack of GRFHx. (shrink)

Post-9/11, concern about bioterrorism has transformed public health from unappreciated to a central component of national security. Within the War on Terror, bioterrorism preparedness has taken a back seat only to direct military action in terms of funding. Domestically, homelessness, joblessness, crime, education, and race relations are just a few of a litany of pressing issues requiring government attention. Even within the biomedical sciences and healthcare, issues surrounding the fact that more than 40 million Americans lack health insurance, the rising (...) cost of prescription medications, and the use of government funds for research using embryonic stem cells remain unresolved. Should we prioritize a hypothetical threat (bioterrorism), or existing conditions that have implications for identifiable individuals? Even more fundamentally, should we prioritize research aimed at defense from bioterrorism (or even terrorism in general) when there are so many pressing social problems that affect the U.S. population? (shrink)

The Target Article by Sabatello et al. should prove significant in advancing recognition of, and discussion concerning how, race is embedded in allocation strategies adopted in pandemic resp...

ABSTRACT Because of the nature of preventive vaccination programs, the viability of these public health interventions is particularly susceptible to public perceptions. This is because vaccination relies on a concept of ‘herd immunity’, achievement of which requires rational public behavior that can only be obtained through full and accurate communication about risks and benefits. This paper describes how irrational behavior that threatens the effectiveness of vaccination programs – both in crisis and non‐crisis situations – can be tied to public perceptions (...) created by media portrayals of health risks. I concentrate on childhood vaccination as an exemplar of ‘non‐crisis’ preventive vaccination, and on the recent flu vaccine shortage as a ‘crisis’ situation. The paper concludes with an examination of the steps necessary to resolve these threats through better public communication. (shrink)

Volume 20, Issue 9, September 2020, Page 60-62.

This paper examines three possible justifications for original ACMG recommendations to return incidental findings from whole exome or genome sequencing independent of patient preferences. The first two potential justifications, based on a patient's authentic values, then on harms to others, are founding lacking as a basis of justification for these recommendations. The third, grounded in analogous professional practices, might serve as a potential justification if several controversies can be avoided. However, given the nature of these controversies and the need to (...) instill public trust in this newly emerging science, the paper finds that updated ACMG recommendations that recognize opt-out rights on behalf of patients is the most prudent, and justifiable, approach. (shrink)

The multidisciplinary nature of bioethics can result in narrow sub-specialists within the field, whose work reflects the issues and concerns most relevant to their home discipline. This can result in work which is insensitive to the important ways in which particular areas of bioethics are interrelated, and which (while viable in the context of the sub-specialty) is not viable in a broader context. The narrow focus of many healthcare ethics committees on issues directly related to clinical patient care can exacerbate (...) this problem. Increasingly, issues in the clinical care of patients cannot be separated from issues in research, organizational ethics, and public policy. I argue that these problems call for a need to identify core areas for bioethics education. This is especially true for education of hospital ethics committees, which incresingly face complex cases involving concerns that fall outside traditional patient care issues. I then consider nine areas examined in detail in A Companion to Bioethics edited by Helga Kuhse and Peter Singer, as potential candidates for core areas of bioethics education. At the same time, I evaluate the range of issues examined in each area of the book, in the context of the books ability to provide an introduction to each area. (shrink)

The American Journal of Bioethics, Volume 12, Issue 10, Page 24-26, October 2012.

The events of September 11, 2001 have prompted significant concern to protect against future terror attacks, especially attacks that would involve the use of biological weapons - the most dangerous weapons of massdestruction considered accessible to terrorist groups and organizations. This concern, in turn, has led to a re-evaluation of the public health system and its preparedness to meet the challenges of treating a large number of people in circumstances of public fear and significant demand for resources. One important result (...) of this re-evaluation has been the development of a Model State Emergency Health Powers Act that is designed to grant state officials the authority necessary to coordinate an effective response to biological tenor. The Model Act was first publicized in late October, 2001,and a revised version was publicized December21, 2001.As of October 1,2002,legislation based on the Act had been introduced in thirty-six states, and versions of the Act had been enacted in twenty states and the District of Columbia. (shrink)

The events of September 11, 2001 have prompted significant concern to protect against future terror attacks, especially attacks that would involve the use of biological weapons - the most dangerous weapons of massdestruction considered accessible to terrorist groups and organizations. This concern, in turn, has led to a re-evaluation of the public health system and its preparedness to meet the challenges of treating a large number of people in circumstances of public fear and significant demand for resources. One important result (...) of this re-evaluation has been the development of a Model State Emergency Health Powers Act that is designed to grant state officials the authority necessary to coordinate an effective response to biological tenor. The Model Act was first publicized in late October, 2001,and a revised version was publicized December21, 2001.As of October 1,2002,legislation based on the Act had been introduced in thirty-six states, and versions of the Act had been enacted in twenty states and the District of Columbia. (shrink)

This paper argues for the importance of the political context of a society for bioethics. In particular, I argue that in a liberal constitutional society, such as the one we find ourselves in, no particular moral perspective is granted a privileged position. Rather, individuals are allowed to live their lives according to values they adopt for themselves, and the rights granted to protect this ability “trump” social consensus, and place boundaries on the social application of personal moral beliefs and values.

: In June 2002, the Advisory Committee on Immunization Practices (ACIP) approved draft recommendations concerning preparation for potential biological terror attacks that utilize the smallpox virus. ACIP recommends against both mandatory and voluntary vaccination of the general public. The present paper examines the moral and political considerations both for and against each of the general public vaccination options considered by the ACIP in the context of the state's authority over vaccination for the purposes of protecting public health. Although it is (...) clear that compulsory mass vaccination is not justified at this time, the issues surrounding voluntary vaccination are more complex. Should smallpox vaccination prior to an outbreak be made available to the general public? The paper concludes that the vaccine should not be made available at this time. This conclusion, however, is based upon contingent features of current circumstances, which would change once an outbreak occurred. In the event of a terror-related outbreak of smallpox, the general public's access to voluntary vaccination would become justified, even in areas beyond where the outbreak has occurred. (shrink)

This paper argues that it will be important for new genomic technologies to recognize the limits of traditional approaches to informed consent, so that other-regarding implications of genomic information can be properly contextualized and individual rights respected. Respect for individual autonomy will increasingly require dynamic consideration of the interrelated dimensions of individual and broader community interests, so that the interests of one do not undermine fundamental interests of the other. In this, protection of individual rights will be a complex interplay (...) between individual and community concerns. (shrink)

Health care workers have not gone along with President Bush's request that they be vaccinated against smallpox in order to prepare the nation's health care system for a terrorist attack using the virus. But there is no professional moral obligation to receive the vaccination—either as a matter of public health or as a matter of national security.

This paper argues that the value of genetic-relative family health history information and the notion that lack of this information is a disadvantage can be established through its role as a nested goal in comprehensive life projects independent of documentation of particular health outcomes. Health information often plays a significant role in a person's formulation of life goals and projects, as well as in identification of plausible effective means to realize these goals. If health outcomes are valuable in part because (...) of the nested role these play in the successful realization of a person's life projects and goals, then other, similarly nested contributors to such success must also be valued on a similar scale. Some of these other contributors to a successful life may themselves be nested with health considerations, as illustrated in the relationship that will be the focus of this paper. Health information --independent of outcomes per se – influences relationships, reproduction, and the formulation of plausible comprehensive life goals in intricate and very influential ways. Although such information may be valued in part because it is predictive of health outcomes, this relationship does not reduce such information, nor the comprehensive life goals and projects such information promotes, to health outcomes. That is, while health status can both enhance and detract from the autonomous pursuit of life projects formulated in the context of health information, the value and weight of these projects is independent of particular health status or outcomes, even while in part shaped by them. (shrink)

The paper ‘Biodefence and the production of knowledge’ by Buchanan and Kelley1 is an extremely valuable addition to the scientific and bioterrorism defence literature. It points out the myriad of ways that the structure of current debates about the dual use problem neglects important values, and discussions of how these values should be considered in policy making. In this commentary, I will focus on only one of these areas: what the authors characterise as ‘dual use opportunity’. My goal is not (...) to challenge the authors’ main points , but to draw out the complicated set of value conflicts that this single area of bioterror defence policy has neglected.Buchanan and Kelley characterise the concept of ‘dual use opportunity’ as the idea that ‘research undertaken for biodefence may contribute, or might be made to contribute, to the alleviation of the burden of disease among the world's worst-off people.’ I have argued for a similar idea of dual use opportunity in a different context by suggesting that we should prioritise global public health infrastructure over narrowly defined research on specific agents and/or projects that seek to prevent altogether biological attacks—a goal that, I have argued, is futile given the almost limitless number of forms of, and mutations to, disease bacteria and viruses that might be employed by biological terrorists.2–5 Effective control of an epidemic requires a fundamental infrastructure of surveillance and reporting. Because the …. (shrink)

Arguments for the provision of foreign aid to help relieve the blight of developing countries have traditionally centred on obligations of benevolence and a duty to help those less fortunate.1 However, the War on Terror has resulted in a significant shift in how foreign aid is perceived. International prosperity and stability are now recognized as key elements in a fight to ameliorate the conditions that give rise to terrorism. Public support for foreign aid in general, normally unpopular, has increased since (...) 11 September 2001 due to greater public understanding of its role in combating terrorism.2 In particular, the need to address attitudes of foreign civilians toward the United States has become more widely recognized as a key component of efforts to reduce the ferment of the terrorist mindset. These strategies have assumed particular importance in light of the non-traditional nature of the threat posed by contemporary terrorism: a threat posed not by states or armies, but by individuals and groups who blend into, garner both the implicit and explicit support of, and are recruited from general civilian populations. (shrink)

Arguments for the provision of foreign aid to help relieve the blight of developing countries have traditionally centred on obligations of benevolence and a duty to help those less fortunate.1 However, the War on Terror has resulted in a significant shift in how foreign aid is perceived. International prosperity and stability are now recognized as key elements in a fight to ameliorate the conditions that give rise to terrorism. Public support for foreign aid in general, normally unpopular, has increased since (...) 11 September 2001 due to greater public understanding of its role in combating terrorism.2 In particular, the need to address attitudes of foreign civilians toward the United States has become more widely recognized as a key component of efforts to reduce the ferment of the terrorist mindset. These strategies have assumed particular importance in light of the non-traditional nature of the threat posed by contemporary terrorism: a threat posed not by states or armies, but by individuals and groups who blend into, garner both the implicit and explicit support of, and are recruited from general civilian populations. (shrink)

In an interesting response to an article I published in CQ that questions the ability of advance directives to reflect autonomy, Christopher Tollefsen raises a number of issues that deserve greater attention. Tollefsen offers several examples to illustrate how the critique of advance directives I offer would also threaten other choices that most people would consider autonomous. Importantly, I largely agree that the examples Tollefsen offers should be captured as autonomous. Where I disagree, however, is whether these examples reflect the (...) particular type of second order decision strategy that I categorize advance directives as, and so whether the critique of advance directives I offer, if accepted, would commit us to an unreasonably narrow conception of autonomy. (shrink)

Numerous grounds have been offered for the view that healthcare workers have a duty to treat, including expressed consent, implied consent, special training, reciprocity (also called the social contract view), and professional oaths and codes. Quite often, however, these grounds are simply asserted without being adequately defended or without the defenses being critically evaluated. This essay aims to help remedy that problem by providing a critical examination of the strengths and weaknesses of each of these five grounds for asserting that (...) healthcare workers have a duty to treat, especially as that duty would arise in the context of an infectious disease pandemic. Ultimately, it argues that none of the defenses is currently sufficient to ground the kind of duty that would be needed in a pandemic. It concludes by sketching some practical recommendations in that regard. (shrink)

Clinicians' fear of malpractice litigation is the most significant obstacle to the open reporting of medical mistakes. Without open reporting of medical mistakes, however, root cause analysis of mistakes cannot be done, thus undermining efforts to implement safeguards to minimize the occurrence of future mistakes. Efforts to prevent medical mistakes, therefore, must first directly address cliniciansÕ fear of malpractice litigation. In this paper, we explore the relationship between the current malpractice system and cliniciansÕ fear of litigation. Ultimately, we argue that (...) both the prevention of medical mistakes and the goals of malpractice litigation itself will be better served if substantial malpractice reform is undertaken. (shrink)

A competent patient has the right to refuse treatment necessary to sustain life. However, for many end-of-life decisions, we lack direct access to the wishes of a competent patient. Some treatment decisions near the end of life involve patients with severely diminished mental capacity, some involve patients who are unable to communicate, and some involve patients who are simply unable or unwilling to participate in decisionmaking due to the nature or severity of their illness.

A good deal of attention has been recently focused on the presumed advertising excesses of the healthcare industry in its promotion techniques to healthcare professionals, whether through offering gratuities such as gifts, honoraria, or travel support2-6 or through deception. Two basic concerns have been expressed: Does the acceptance of gratuities bias the recipient, tainting his or her responsibilities as the patient's agent? Does acceptance of the gratuity by the healthcare professional contribute to the high cost of healthcare products? The California (...) Society of Hospital Pharmacists was recently asked by its members to formulate a policy for an appropriate relationship between the Society and the healthcare industry, addressing these concerns. In formulating its policy, it became clear that the Society depended on healthcare industry support, gathered through journal advertising, fees for booths at its various educational events, and grants for speakers. (shrink)

In an interesting response to an article I published in CQ that questions the ability of advance directives to reflect autonomy, Christopher Tollefsen raises a number of issues that deserve greater attention. Tollefsen offers several examples to illustrate how the critique of advance directives I offer would also threaten other choices that most people would consider autonomous. Importantly, I largely agree that the examples Tollefsen offers should be captured as autonomous. Where I disagree, however, is whether these examples reflect the (...) particular type of second order decision strategy that I categorize advance directives as, and so whether the critique of advance directives I offer, if accepted, would commit us to an unreasonably narrow conception of autonomy. (shrink)

The target article by Christopher Meyers concerning justification of deception for clinical ethicists is both well-reasoned and plausible. Clearly grounded in utilitarian considerations, its...

Volume 20, Issue 7, July 2020, Page 125-128.

Thomas Reid was a philosopher who founded the Scottish school of 'common sense'. Much of Reid's work is a critique of his contemporary, David Hume, whose empiricism he rejects. In this work, written after Reid's appointment to a professorship at the university of Glasgow, and published in 1785, he turns his attention to ideas about perception, memory, conception, abstraction, judgement, reasoning and taste. He examines the work of his predecessors and contemporaries, arguing that 'when we find philosophers maintaining that (...) there is no heat in the fire, nor colour in the rainbow … we may be apt to think the whole to be only a dream of fanciful men, who have entangled themselves in cobwebs spun out of their own brain'. Written by one of the Scottish Enlightenment's most important thinkers, this work brings to life the intellectual debates of the time. (shrink)

The crisis in donor organ and tissue supply is one of the most difficult challenges for transplant today. New policy initiatives, such as the driver's license option and requiredrequest, have been implemented in many states, with other initiatives, such as mandatedchoice and presumedconsent, proposed in the hopes of ameliorating this crisis. At the same time, traditional acquisition of organs from human cadavers has been augmented by living human donors, and nonheartbeating human donors, as well as experimental animal and artificial sources. (...) Despite these efforts, the crisis persists and is perhaps most tragic when it threatens the lives of children, driving parents to sometimes desperate measures. Herein, we address one very controversial step some parents have taken to obtain matching tissue or organs for their needy children—that is, having a child, in part, for the purpose of organ or tissue procurement. (shrink)

Deception, cheating, and loopholes within the IRB approval process have received significant attention in the past several years. Surveys of clinical researchers indicate common deception ranging from omitting information to outright lying, and controversy surrounding the FDA's decision not to ban “IRB shopping” (the practice of submitting protocols to multiple IRBs until one is found that will approve the protocol) has raised legitimate concerns about the integrity of the IRB process. While at first blush these practices seem to cast aspersions (...) on the integrity of clinical researchers, the moral issues raised go deeper than the ethics of cheating. To the extent that these practices are common, or represent an IRB system that places unreasonable burdens on those seeking IRB approval, we should consider whether non-compliance reflects problems of normative legitimacy for the IRB system itself. (shrink)