The prospect for widespread therapeutic use of human fetal tissues has aroused strong emotions and prompted several objections. Fetal tissue transplantation circumscribed by medical and moral limits will not erode important ethical values, but the pace of scientific research must not preempt public debate and a verdict consistent with societal values.

In recent months, Covid‐19 has devastated African American communities across the nation, and a Minneapolis police officer murdered George Floyd. The agents of death may be novel, but the phenomena of long‐standing epidemics of premature black death and of police violence are not. This essay argues that racial health and health care disparities, rooted as they are in systemic injustice, ought to carry far more weight in clinical ethics than they generally do. In particular, this essay examines palliative and end‐of‐life (...) care for African Americans, highlighting the ways in which American medicine, like American society, has breached trust. In the experience of many African American patients struggling against terminal illness, health care providers have denied them a say in their own medical decision‐making. In the midst of the Covid‐19 pandemic, African Americans have once again been denied a say with regard to the rationing of scarce medical resources such as ventilators, in that dominant and ostensibly race‐neutral algorithms sacrifice black lives. Is there such thing as a “good” or “dignified” death when African Americans are dying not merely of Covid‐19 but of structural racism? (shrink)

Reid said little in his published writings about his contemporary Joseph Priestley, but his unpublished work is largely devoted to the latter. Much of Priestley's philosophical thought- his materialism, his determinism, his Lockean scientific realism- was as antithetical to Reid's as was Hume's philosophy in a very different way. Neither Reid nor Priestley formulated a full response to the other. Priestley's response to Reid came very early in his career, and is marked by haste and immaturity. In his last decade (...) Reid worried much about Priestley's materialism, but that concern never reached publication. I document Reid's unpublished response to Priestley, and also view Reid's response from Priestley's perspective, as deduced from his published works. Both thinkers attempted to base their arguments on Newtonian method. Reid's position is the more puzzling of the two, since he nowhere makes clear how Newtonian method favours mind-body dualism over materialism, which is the central debate between them. (shrink)

Reid said little in his published writings about his contemporary Joseph Priestley, but his unpublished work is largely devoted to the latter. Much of Priestley's philosophical thought- his materialism, his determinism, his Lockean scientific realism- was as antithetical to Reid's as was Hume's philosophy in a very different way. Neither Reid nor Priestley formulated a full response to the other. Priestley's response to Reid came very early in his career, and is marked by haste and immaturity. In his last decade (...) Reid worried much about Priestley's materialism, but that concern never reached publication. I document Reid's unpublished response to Priestley, and also view Reid's response from Priestley's perspective, as deduced from his published works. Both thinkers attempted to base their arguments on Newtonian method. Reid's position is the more puzzling of the two, since he nowhere makes clear how Newtonian method favours mind-body dualism over materialism, which is the central debate between them. (shrink)

Deception of subjects is used frequently in the social sciences. Examples are provided. The ethics of experimental deception are discussed, in particular various maneuvers to solve the problem. The results have implications for the use of deception in the biomedical sciences.

Two articles in this issue of the Hastings Center Report address the continuing controversy over the Surfactant, Positive Pressure, and Oxygenation Randomized Trial (SUPPORT). This controversy is part of a larger discussion about the appropriate regulatory framework for protecting human research participants in comparative effectiveness research (CER), a group of studies that aims to compare two “usual” or “standard” treatments in order to provide evidence of which treatment is most effective.

A commentary on a special report, titled Narrative Ethics: The Role of Stories in Bioethics, that appeared with the January‐February 2014 issue.

Laura Specker Sullivan's article “Trust, Risk, and Race in American Medicine” is a philosophically grounded and highly practical call for medical professionals to take on the task of comprehending the sources of patients’ mistrust. This is not only a clinical competence but also a moral obligation, in particular, when mistrust is warranted—as with African American patients who rely on medical institutions that have breached and continue to breach the trust of their communities. While Specker Sullivan focuses on how clinicians can (...) signal comprehension once it has already been attained, I wish to step back and examine the nature of the efforts to gain knowledge. The effort to comprehend requires, at a minimum, the following actions: educating oneself about medical racism, examining one's implicit biases, and engaging, with empathic curiosity, with the patient or family members in the clinical encounter at hand. (shrink)

Drug companies are moving their research from academic medical centers to physicians’ private offices. The shift brings in more subjects, and could mean faster and better results. It also changes the physician's relationship to patients, dangles monetary lures in front of physicians, and could produce subjects who don't understand what they're participating in and results that are unreliable.

This is a brief exposition, at an elementary level, of the differences between a "causalist," or more specifically a utilitarian, ethics and a "taboo," or intuitionist ethics, with respect to the use of compulsion in spare parts surgery. the argument was that the utilitarian sees individuals less as "owners" of their bodies, with inalienable rights over them, but more as resources which can be used for the benefit of society at large. it is suggested that it would be extraordinarily difficult (...) to insert such a view of our bodies into our everyday view of ourselves. (shrink)

Massachusetts's new health insurance law has been shaped by much more than presidential politics. Ten years of evolving policy on health insurance and hospital finance have exerted powerful influences. Ironically, enacting universal access required paying hospitals much more money for their currently insured patients. This costly compromise may destabilize the law's implementation.

: Bioethicists have failed to understand the pervasively paternalistic character of research ethics. Not only is the overall structure of research review and regulation paternalistic in some sense; even the way informed consent is sought may imply paternalism. Paternalism has limits, however. Getting clear on the paternalism of research ethics may mean some kinds of prohibited research should be reassessed.

The view that research with competent adults requires valid consent to be ethical perhaps finds its clearest expression in the Nuremberg Code, whose famous first principle asserts that “the voluntary consent of the human subject is absolutely essential.” In a similar vein, the United Nations International Covenant on Civil and Political Rights states that “no one shall be subjected without his free consent to medical or scientific experimentation.” Yet although some formulations of the consent principle allow no exceptions, others hold (...) that informed consent is not always strictly necessary for ethical research. The U.S. federal regulations known as the “Common Rule,” which govern research with human subjects, lists several conditions for waiving consent. However, neither guidance documents on the ethics of clinical research nor the literature in bioethics contains a general justification of research without consent. The purpose of this paper is to advance a justificatory framework that will explain why research without consent is permissible in paradigmatic cases and that can be useful in analyzing cases about which there is disagreement. We argue that research without consent can be justified on two grounds: if it stands to infringe no right of the participants and obtaining consent is impracticable, or if the gravity of the rights infringement is minor and outweighed by the expected social value of the research and obtaining consent is impracticable. (shrink)

Book reviewed in this article: The Moral Foundations of Professional Ethics. By Alan H. Goldman.

Book reviewed in this article: Deciding Who Lives: Fateful Choices in the Intensive Care Nursery. By Renée R. Anspach.

If the practice of maternal‐fetal medicine sometimes results in abortion, can a physician strongly opposed to abortion maintain his own integrity and still practice in this field?

From the start, I followed the case of Jahi McMath with great interest. In December 2013, she clearly fulfilled the diagnostic criteria for brain death. As a neurologist with a special interest in chronic brain death, I was not surprised that, after she was flown to New Jersey, where she became statutorily resurrected and was treated as a comatose patient, Jahi's condition quickly improved. In 2014, her family reported that she sometimes responded to simple motor commands. I shared the general (...) skepticism regarding these reports, assuming that the family was in denial and was misinterpreting spinal myoclonus (a rapid, involuntary twitch generated by the spinal cord) as volitional. The family had noticed that when Jahi's heart rate was above eighty beats per minute, she was more likely to respond, as though the heart rate reflected some sort of inner level of arousal. So they began to make video recordings. I have been privileged to be entrusted with copies of these recordings, forty‐eight of which proved suitable for assessing alleged responsiveness. All have been certified by a forensic video expert as unaltered. The first thing that struck me was that the great majority of the alleged responses were not spinal myoclonus. In fact, they did not resemble any type of spontaneous, involuntary movement described in patients paralyzed from high spinal cord lesions. (shrink)

At its inception, “brain death” was proposed not as a coherent concept but as a useful one. The 1968 Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death gave no reason that “irreversible coma” should be death itself, but simply asserted that the time had come for it to be declared so. Subsequent writings by chairman Henry Beecher made clear that, to him at least, death was essentially a social construct, and society could define (...) it however it pleased. The first widely endorsed attempt at a philosophical justification appeared thirteen years later, with a report from the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research and a seminal paper by James Bernat, Charles Culver, and Bernard Gert, which introduced the insightful tripartite scheme of concept, criterion, and tests for death. Their paper proposed that the correct concept of death is the “permanent cessation of functioning of the organism as a whole,” which tenuously remains the mainstream concept to this day. In this essay, I focus on this mainstream concept, arguing that equating brain death with death involves several levels of incoherence: between concept and criterion, between criterion and tests, between tests and concept, and between all of these and actual brain death praxis. (shrink)

Home births entail a definite small risk, of unknown magnitude. Hospital births entail a wider range of risks, whose magnitude may be large but is also unknown. The morality of home births should be decided on a case‐by‐case basis, according to these priorities: safety of the mother, safety of the fetus, benefit to the fetus, potential benefit to the mother.

Book reviewed in this article: Prospects for a Common Morality. Edited by Gene Outka and John P. Reeder, Jr.