Perspectives in Biology and Medicine

Assumptions that bioethics was intended to focus only on a narrow set of issues related to research and health care are mistaken. The field of bioethics has long been focused on pressing contemporary issues, and it will play an unduly peripheral and less significant role than it could otherwise if it fails to focus on a broad set of issues, including human relations and the relationship of humans to nonhuman beings and the environment-and if it does not consider how to engage with others in addressing these issues...

The relationship between equality and equity has been theorized and described in many ways. Recently, this relationship has been popularly illustrated via a meme depicting three people watching a baseball game while standing on boxes. The meme's analogy, that achieving health equity is the ability to view a spectator sport, is a neoliberal account of health. The analogy defines equality at the expense of equity, characterizes health as individualistic, describes health equity as a static outcome, and implies that the bioethical questions for achieving health equity are about the distribution and redistribution of resources...

Many of humanity's most serious problems are global, intergenerational, and ecological, yet current institutions are poorly placed to confront such problems. In part, this institutional challenge reflects difficulties with our basic concepts and theories. Bioethics is a central area where such questions arise. Although some have argued for an environmentalized bioethics since its inception, biomedicine has thus far failed to embrace the challenge, and some accuse most bioethicists of being "asleep at the wheel" (Schenck and Churchill 2021)...

It may be too late to avoid the climate crisis, likely to be humanity's most expensive, widespread, and enduring catastrophe. This is a qualitatively different kind of catastrophe, in which increased costs, decreased revenue, and no possibility of bailout force communities to harshly cut budgets, especially in health care. Little is known about making such brutal cuts fair or efficient, nor how to help the public accept them. The crisis presents an opportunity for bioethicists to play a crucial role, but one for which traditional approaches are inherently inadequate...

Planet Earth and its growing human population are challenged by the health impacts of industrial policies that drive global emissions production and cause climate change. The health-care industry has capacity and responsibility to adopt environmentally sustainable policies and practices. Bioethicists have a responsibility to support environmental sustainability through their clinical, research, educational, and policy work. They communicate complex ideas to diverse stakeholders and can communicate similarly to improve understanding about emissions and the value of environmentally sustainable policy...

When considering the health and flourishing of humans and human communities, we cannot ignore that we are constitutively bound to the health of ecosystems of which we are a part. As such, global climate change is a central concern for health care and bioethics. Addressing the complex and interrelated realities bound up with global climate change requires a multifaceted and integrated approach from diverse academic and professional disciplines and perspectives. This essay offers a brief conceptual framing of Vanderbilt University Medical Center's (VUMC) Center for Biomedical Ethics and Society's Rooted Community Health (RCH) programmatic initiative, with particular focus on how medical ethics provides necessary insight into the intersection of climate change and health and how RCH has turned these insights into actionable practices of care in the VUMC and Middle Tennessee Communities...

The bioethics literature has paid little attention to resistance to COVID-19 vaccination, despite the safety and effectiveness of vaccines and the heavy death toll of the virus. A narrative approach to the problem might begin with descriptions of good and bad narratives about vaccination. Bad stories about vaccination tend to be constructed backwards, starting with the desired conclusion (vaccination is dangerous or ineffective) and from that filling in needed "facts" to support the conclusion. Physicians need to act in more trustworthy ways in order to convince at least some patients to consider vaccination...

This symposium contribution argues that politicized responses to the COVID-19 pandemic mark the fracturing of the consensus that bioethics has been built upon. This consensus involved the mutual dependence of principles and stories: principles need stories to become applicable in clinical action, and stories need to reflect principles if they are to make generalized claims. Two mid-20th-century theorists, Erving Goffman and Walter Benjamin, each predicted the thinness of appeals to principles and to stories, respectively; their skepticism describes our moment...

The foundation story of bioethics is, as Susan Reverby (2009) argues, one of a trinity of horror stories culminating in what we commonly call the "Tuskegee Syphilis Study." The foundation story emphasizes that medical researchers violated participant autonomy by deceiving them about their medical conditions, the goals of the study, and the treatments they would receive, and by failing to consider the health and best interests of the research participant. While this story reflects some key elements of the Tuskegee study, it is only a selection of all the possible facts that, as a consequence, deflects attention from equally salient and problematic elements of the Public Health Service's unethical study and its context...

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In his book For the Common Good: Philosophical Foundations of Research Ethics (2022), Alex John London argues that the current framework for human research ethics and oversight is an assortment of rules, procedures, and guidelines built upon mistaken assumptions, policies, and practices that create spurious dilemmas and serious moral failings. He claims that his theory can fix these problems by placing human participant research on a solid philosophical foundation. London argues that human participant research is a social activity guided by principles of justice, in which free and equal individuals work together to promote the common good...

We suffer from a radical autonomy which too often collapses the therapeutic alliance between patient and physician into a health-care transaction between consumer and provider, a fee-for-service exchange for something far short of true health. Some ethicists and physicians are seeking a better way, by employing a virtue ethics approach in which health is seen as a distinct good and the proper end of a medical encounter. Curlin and Tollefsen's The Way of Medicine (2021) synthesizes this material into a heuristic contrasting what they characterize as the Provider Services Model and the Way of Medicine...

While shared decision-making (SDM) is generally considered to be the standard in current clinical practice, strict application of SDM can result in adverse outcomes in certain contexts. This article examines two illustrative cases-antibiotic over-prescription and decision-making at or near the end of life-to highlight how strictly applied SDM can result in suboptimal outcomes. The article continues to describe how strategies from libertarian paternalism, particularly default setting, framing, and nudging, can be valuable tools in supplementing strict applications of SDM, resulting in improved outcomes and patient care on both individual and societal levels...

Educating medical students to be physicians involves many dimensions. But in an educational culture where science and technology dominate the curriculum, these subjects also too often dominate the academic value system as well. While a firm grasp of scientific knowledge and technical skill is essential, cultivating humanistic virtues is at the core of all good medical care and the full well-being of those within it. This article describes a formative educational process that points towards compassionate flourishing and unfolds through dialogue and reflection on the human aspects of patient care and the student experience, a process coequal in value to scientific development...

An important but little-known step in the cloning of genes took place in Geneva in 1975. Bypassing the enormous complexity of total genomic DNA, it allowed for the cloning, identification, study, and use of all genes that have been isolated ever since. Bernard Mach was head of the Geneva laboratory where this discovery took place. As interviewed by physician-historian Jacalyn Duffin, he explains the nature of the 1975 procedure and highlights the role that this discovery played in the fields of biology, genetic medicine, and biotechnology...

Over the last 80 years, a series of critical events has led to reconsideration of the basic premises of medical ethics. One of these events was the recognition of horrific medical experiments performed by German medical scientists in World War II concentration camps, resulting in intensified emphasis on a consent requirement, later understood as grounded in the bioethical principle of respect for autonomy, as well as on the moral accountability of the experimenter. Another important event that is forcing a reconsideration of respect for autonomy in medicine and health care is the COVID-19 pandemic...

The evolution of self-replicating biological species required the prebiotic evolution of fundamental chemical compounds that facilitate critical redox reactions, including chiefly the oxidation of water, the reduction of molecular oxygen, and redox transitions of partially reduced forms of oxygen (reactive oxygen species). The fundamental catalysts for these reactions are porphyrins. Chemically versatile, photoreactive, and redox-active, porphyrins (or their primary precursor, porphin) are believed to have evolved prebiotically in an enthalpically feasible series of reactions...

Genetic essentialism is the notion that genes can reveal to us the core of what it means to be humans and individuals, that our genes are the ultimate source of who we are and who we have been and will be. A recent collection of articles in a special issue of the Hastings Center Report describes the current standing of this term as embattled and potentially oversold but not necessarily without merit. This article highlights particularly valuable insights from the special issue and provides a novel insight into the movement of genetic essentialist attitudes into historically separate domains of medical knowledge-making, or the "social warranting" of genetic epistemology...

Over recent decades, progress in bioscience research has been remarkable, but alongside the many transformative advances is a growing concern that a surprisingly high fraction of published research cannot be reproduced by the scientific community. Though experimental and interpretive errors are unavoidable features of the scientific process, recent evidence suggests that irreproducibility is a serious issue requiring analysis, understanding, and remediation. This article reviews the meaning of research reproducibility, examines ongoing efforts to estimate its prevalence, and considers the factors that contribute to it...

While there is voluminous literature on pain in the context of medicine, pain as an aesthetic, representational, and epistemological issue remains undertheorized. The present article, after reviewing the nature of pain and surveying the emerging interdisciplinary field of graphic medicine, seeks to close-read sections of Georgia Webber's Dumb (2018) to demonstrate how the artist transforms the inexpressibility and invisibility of pain into a visual and sensate language. Webber's Dumb articulates a complex sense of pain, in which pain is conceived at once as a generative and also as a disabling force...