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Perspectives in Biology and Medicine

David Resnik
On March 28, 2017, the National Academy of Sciences, Engineering, and Medicine (NASEM) released a much-anticipated report on the Environmental Protection Agency's controlled human inhalation exposure studies. This essay reviews the ethical controversies that led to the genesis of the report, summarizes its key findings, and comments on its approach to informing human subjects about the risks of inhalation exposure studies. NASEM's report makes a valuable contribution to our understanding of the scientific and ethical issues involved in conducting human inhalation exposure studies...
2017: Perspectives in Biology and Medicine
Nancy E Kass
While medical ethics has a long history, and research ethics guidance emerged more formally in the 1960s and 1970s, frameworks for public health ethics began to appear in the 1990s. The author's thinking about public health ethics evolved from consideration of some of the ethics and policy questions surfacing regularly in the HIV/AIDS epidemic. This essay discusses some of the shared commitments of public health and ethics, as well as how one might apply an ethics lens to public health programs, both generally and in the contexts of public health preparedness and obesity prevention...
2017: Perspectives in Biology and Medicine
Hilde Lindemann
This essay lays out some of the many resources that a background in literary studies has to offer bioethics. After identifying four useful characteristics of stories, it briefly discusses some kinds of moral work that stories can be put to, including countering ethically undesirable stories and modeling ethically troubling situations. Stories can be invoked in our moral reasoning, compared and parsed, and used to teach moral lessons. They can help us discern which moral concepts are operative in a specific instance...
2017: Perspectives in Biology and Medicine
Raymond De Vries
C. Wright Mills said that when done well, sociology illuminates the intersection of biography and history. This essay examines how the author's vocational choices and career path were shaped by historical circumstance, leading him to a degree in sociology and to participation in the odd and interesting interdiscipline of bioethics. Drawing on a distinction between sociology in bioethics and sociology of bioethics, the essay considers the value of sociology to the bioethical project.
2017: Perspectives in Biology and Medicine
Jonathan D Moreno
This essay provides a rational reconstruction of the author's genetically inscribed inclination to do normative ethics with an historical bent and offers some reflections on the value of historical thinking for bioethics.
2017: Perspectives in Biology and Medicine
Rebecca Dresser
Fascination with In re Quinlan, the first high-profile right-to-die case in the United States, led the author to law school. By the time she received her law degree, bioethics was emerging as a field of study, and law and bioethics became her field. The mission of legal education is to teach students to "think like a lawyer," which can be a productive way to approach issues in many fields, including bioethics. Legal education can also teach individuals to respect people whose views on bioethics issues differ from their own...
2017: Perspectives in Biology and Medicine
Connie M Ulrich
Nurses, one of the most trusted professional groups in our society, work with patients and their families at all stages of the illness trajectory. Nurse bioethicists are a small but special subset of the nursing profession and bioethics community, focusing on the moral complexities that arise in clinical care, research, and health policy. This article examines the career trajectory of a nurse bioethicist and the clinical, educational, and research experiences that shaped her career goals. It also addresses the uniqueness of nursing and the ethical challenges that nurse's encounter in their day-today interactions with diverse patient populations and calls for distinct conceptual and empirical bioethics inquiry...
2017: Perspectives in Biology and Medicine
Joseph J Fins
Through this autobiographical reflection on a life in medicine and bioethics, the author discovers that time is a unifying theme in his work. From his early writing on the regulation of house staff work hours and his abandonment of essentialism and the development of clinical pragmatism as a method of moral problem-solving to his scholarship on end-of-life care and disorders of consciousness, time has been a central heuristic in an effort to bridge ethical theory and clinical practice.
2017: Perspectives in Biology and Medicine
Franklin G Miller
Philosophy is a core discipline that has contributed importantly to bioethics. In this essay, the author traces his trajectory from philosophy to bioethics, oriented around the theme of challenging the conventional wisdom. Three topics are discussed to illustrate this theme: the ethics of randomized trials, determination of death and organ transplantation, and pragmatism as a method of bioethics. In addition, the author offers some general reflections on the relationship between philosophy and bioethics. Philosophy recovers itself when it ceases to be a device for dealing with the problems of philosophers and becomes a method, cultivated by philosophers, for dealing with the problems of men...
2017: Perspectives in Biology and Medicine
Franklin G Miller, Joseph J Fins
No abstract text is available yet for this article.
2017: Perspectives in Biology and Medicine
Franklin G Miller
This review essay reflects on the remarkable best-selling book, When Breath Becomes Air (2016), by Paul Kalanithi, a young neurosurgeon. The author's moving narrative displays clinical and existential wisdom and offers rich food for thought regarding both what it means to be a doctor and the experience of facing death from metastatic lung cancer.
2016: Perspectives in Biology and Medicine
Arthur W Frank
This review essay situates Abraham Nussbaum's The Finest Traditions of Our Calling (2016) within the contemporary genre of physician memoirs that shade into critiques of institutional medicine. Nussbaum's primary concern is the demoralization of medicine as it becomes increasingly monetized; patients are reduced to body parts and reimbursement schedules. He argues that physicians continue to have considerable choice in how they practice, despite institutional constraints. For bioethics, Nussbaum's advocacy of virtue ethics is notable...
2016: Perspectives in Biology and Medicine
Paul K Han
Disclosure of prognosis in end-of-life care is a practice that is widely and increasingly recommended. However, prognostic disclosure is known to be resisted by many dying persons and by physicians, who instead engage in a "collusion of silence"-discussing prognosis either not at all or in vague, indirect terms. Debates about the ethics of prognostic disclosure and non-disclosure have tended to focus on their relative benefits and harms, or on the psychological acceptability of prognostic information to dying persons...
2016: Perspectives in Biology and Medicine
Daniel P Sulmasy
Reading the following brief piece depends on having some knowledge of the famous essay to which it refers, Francis W. Peabody's "The Care of the Patient," published 90 years ago in the Journal of the American Medical Association (JAMA 88: 877-82). Peabody's essay was based on a talk he gave to Harvard medical students in 1925, and it was published shortly before his premature death in 1927. At the time, he was highly regarded as a consummate clinician and teacher, and in his essay, he laments problems he already saw affecting medical practice, such as the overvaluation of science relative to clinical medicine and a diminishing spirit of attentiveness to the most deeply human needs of patients...
2016: Perspectives in Biology and Medicine
Camilla Hoffmann Merrild, Peter Vedsted, Rikke Sand Andersen
This article suggests that in order to understand the social differences evident in disease prevalence and outcomes, it is necessary to understand what it means to live with multiple social, physical, and psychological challenges. Drawing on research in cancer diagnosis, we discuss practices of health, illness, and care-seeking. We suggest that the focus on lifestyle and behavioral change that dominates contemporary public health interventions should be complemented with a Weberian circumstantial approach. Acknowledging the situatedness of health and illness practices may enable us to help our patients gain access to, and benefit from, the health-care system...
2016: Perspectives in Biology and Medicine
Abram Brummett
Some contributors to the cognitive enhancement (CE) debate claim to take a "public health" approach. However, authors who use this stance end up offering very different recommendations for CE. Some argue for bioconservatism, others for transhumanism-all in the name of "public health." This article argues that these inconsistencies occur because a "public health approach" is far too vague. Furthermore, public health approaches are silent on an issue that drives a great deal of the disagreement over CE: differences in anthropology...
2016: Perspectives in Biology and Medicine
Charles J Kowalski, Adam J Mrdjenovich
This essay combines our thoughts concerning the generally destructive practice of dichotomization with a selective review of the literature supporting our critique. The apparent simplicity of dichotomous thinking encourages its use even when a dyadic representation is totally inadequate to understanding complex situations, and this "simpler is better" mantra continues to stymie our understanding of many of the world's complexities. The identification and naming of two distinct, opposing categories often results in their being seen as in opposition to one another, and that it is somehow incumbent upon us to choose one or the other...
2016: Perspectives in Biology and Medicine
Anne Ashley Davenport
This article reviews key aspects of the history of the emergence of palliative care to point out that the language and expressions that are routinely used in communicating with palliative care patients are often infused with an unrecognized religious coloration.
2016: Perspectives in Biology and Medicine
Daniel Benjamin, Jonathan Kimmelman
Several studies suggest that clinical researchers are prone to overestimating the chance that scientific protocols will succeed, say, by confirming a treatment hypothesis or reaching recruitment targets. In this essay, we address the normative question of whether such "unrealistic optimism" is harmful in clinical research. We entertain five plausible defenses of unrealistic optimism: agnosticism (optimism cannot be objectively assessed), skepticism (expressions of unrealistic optimism are difficult to interpret, since researchers are not accustomed to thinking in terms of probability), contrarianism (unrealistic optimism is salutary), denialism (any effects of unrealistic optimism are neutralized by oversight mechanisms), and fatalism (nothing can be done to alter unrealistic optimism or its effects)...
2016: Perspectives in Biology and Medicine
Johann-Peter Kuhtz-Buschbeck, Reidar K Lie, Jochen Schaefer, Nicolaus Wilder
This article explores the importance of diagrams in the history of the understanding of cardiac function, by comparing Ernest Starling's famous "Law of the Heart" (1918) with the mathematically based view of cardiac mechanics put forward by Otto Frank (1897). Whereas Frank's diagrams gained influence in German cardio-physiological publications, they were widely unknown abroad until 1969, when Hiroyuki Suga began to present similar approaches for warm-blooded animals as Frank had done for the frog. Suga succeeded in correlating the pressure volume area (PVA)-a composite of Frank's work loop plus the area of remaining potential energy-with the oxygen consumption of the beating heart...
2016: Perspectives in Biology and Medicine
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