If particularism is right, the broad moral claims we make are usually riddled with exceptions. But such generalizations can still be a useful, even necessary part of moral life. They help us show what we should do, and they are essential for understanding why we should do it.

Book reviewed in this article: Having Children: Philosophical and Legal Reflections on Parenthood. Edited by Onora O'Neill and William Ruddick.

The moral expertise of clinical ethicists is not a question of mastering codelike theories and lawlike principles. Rather, ethicists are architects of moral space within the health care setting, as well as mediators in the conversations taking place within that space.

If you developed Alzheimer disease, would you want to go all the way to the end of what might be a decade‐long course? Some would; some wouldn't. Options open to those who choose to die sooner are often inadequate. Do‐not‐resuscitate orders and advance directives depend on others' cooperation. Preemptive suicide may mean giving up years of life one would count as good. Do‐it‐yourself methods can fail. What we now ask of family and clinicians caring for persons with dementia, and of (...) patients given no better option than to go on with lives they may not want, is unacceptable. To explore how one might better control one's own dying and avoid burdening others with overwhelming care and morally painful choices, we propose a thought experiment: an advance directive implant that would enable persons with early dementia, while competent, to arrange their own deaths without the subsequent intervention of anyone else. (shrink)

Book reviewed in this article: Am I My Parents' Keeper? An Essay on Justice Between the Young and Old. By Norman Daniels.

Book reviewed in this article: The Most Useful Gift: Altruism and the Public Policy of Organ Transplants. By Jeffrey Prottas.

A three‐tiered legal structure of the substances constitutive of human beings can accommodate property rights in new products created by the investment of labor in human tissue.

Book reviewed in this article: Am I My Parents' Keeper? An Essay on Justice Between the Young and Old. By Norman Daniels.

Book reviewed in this article: The Most Useful Gift: Altruism and the Public Policy of Organ Transplants. By Jeffrey Prottas.

Book reviewed in this article: Having Children: Philosophical and Legal Reflections on Parenthood. Edited by Onora O'Neill and William Ruddick.

Book reviewed in this article: Medicine, Society, and Faith in the Ancient and Medieval Worlds. By Darrel W. Amundsen.

Reasoning well about risk is most challenging when a woman is pregnant, for patient and doctor alike. During pregnancy, we tend to note the risks of medical interventions without adequately noting those of failing to intervene, yet when it's time to give birth, interventions are seldom questioned, even when they don't work. Meanwhile, outside the clinic, advice given to pregnant women on how to stay healthy in everyday life can seem capricious and overly cautious. This kind of reasoning reflects fear, (...) not evidence. (shrink)

The health care needs of rural populations often differ from those of their urban counterparts. And the ethical dilemmas that caregivers face are distinctively shaped in rural settings, not only by resource constraints, but by the nature of life in small, close-knit communities as well.

This article is the lead piece in a special report that presents the results of a bioethical investigation into chimeric research, which involves the insertion of human cells into nonhuman animals and nonhuman animal embryos, including into their brains. Rapid scientific developments in this field may advance knowledge and could lead to new therapies for humans. They also reveal the conceptual, ethical, and procedural limitations of existing ethics guidance for human‐nonhuman chimeric research. Led by bioethics researchers working closely with an (...) interdisciplinary work group, the investigation focused on generating conceptual clarity and identifying improvements to governance approaches, with the goal of helping scholars, funders, scientists, institutional leaders, and oversight bodies (embryonic stem cell research oversight [ESCRO] committees and institutional animal care and use committees [IACUCs]) deliver principled and trustworthy oversight of this area of science. The article, which focuses on human‐nonhuman animal chimeric research that is stem cell based, identifies key ethical issues in and offers ten recommendations regarding the ethics and oversight of this research. Turning from bioethics’ previous focus on human‐centered questions about the ethics of “humanization” and this research's potential impact on concepts like human dignity, this article emphasizes the importance of nonhuman animal welfare concerns in chimeric research and argues for less‐siloed governance and oversight and more‐comprehensive public communication. (shrink)

A central problem for the international governance of heritable germline gene editing is that there are important differences in attitudes and values as well as ethical and health care considerations around the world. These differences are reflected in a complicated and diverse regulatory landscape. Several publications have discussed whether reproductive uses would be legally permissible in individual countries and whether clinical applications could emerge in the context of regulatory gaps and gray areas. Systematic comparative studies that explore issues related to (...) the governance of this technology from different national and international perspectives are needed to address the lack of knowledge in this area. In this research report, we contribute to filling this gap by presenting views of stakeholders in the United Kingdom on challenges to the governance of heritable genome editing. We present findings from a multistakeholder study conducted in the United Kingdom between October 2016 and January 2018 and funded by the Wellcome Trust. This research included interviews, literature analysis, and a workshop. We involved leading U.K. scientists, in vitro fertilization clinicians, and representatives from regulatory bodies, patient organizations, and other civil societal organizations, as well as fertility companies. Part one of this article explores stakeholder perceptions of possible global developments in heritable genome editing and associated risks and governance challenges. Part two presents a range of policy options that were generated during the workshop in relation to the challenges discussed in part one. (shrink)

The notion of virtue in general, and courage in particular, has had a hard time integrating itself into the everyday lexicon of bioethics. Following the lead of enlightenment moral philosophy, which concentrates on the theory of right action as opposed to the ancient Greeks' emphasis on the development of good character, bioethics, with some notable exceptions, has tended to relegate consideration of the virtues to the sidelines of moral argument. Recently, however, there have been calls for the necessity of “moral (...) courage” in the context of clinical ethics. As nurses, physicians, and other health care professionals confront a variety of moral contexts in which the virtue of courage is invoked to "do the right thing," stand up for patients' rights, and uphold the ethical standards of their professions, they are increasingly reminded of their moral duty to exhibit courage in the face of institutional obstacles to the proper care of their patients. For example, a nurse's hesitation to approach a physician to request increased sedation for an agitated patient out of fear of retaliation is represented in one article as a lack of courage.In this paper we offer a critical assessment of such invocations of courage. While we find courage to be an indispensable virtue in some challenging contexts, in other settings we find invocations of courage to be both an unfortunate endorsement of an oppressive status quo that can divert attention from the real problems and an undesirable and potentially destructive strategy within health care institutions whose goal is medically excellent and morally good clinical practice. As we shall argue, a call to virtuousness is not always virtuous. (shrink)

U.S. researchers and scholars often point to two legal factors as significant obstacles to the inclusion of pregnant women in clinical research: the Department of Health and Human Services’ regulatory limitations specific to pregnant women's research participation and the fear of liability for potential harm to children born following a pregnant woman's research participation. This article offers a more nuanced view of the potential legal complexities that can impede research with pregnant women than has previously been reflected in the literature. (...) It reveals new insights into the role of legal professionals throughout the research pathway, from product conception to market, and it highlights a variety of legal factors influencing decision-making that may slow or halt research involving pregnant women. Our conclusion is that closing the evidence gap created by the underrepresentation and exclusion of pregnant women in research will require targeted attention to the role of legal professionals and the legal factors that influence their decisions. (shrink)