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Hastings Center Report

Michael Hauskeller
In Phenomenological Bioethics: Medical Technologies, Human Suffering, and the Meaning of Being Alive, the Swedish philosopher Fredrik Svenaeus aims to show how the continental tradition of phenomenology can enrich bioethical debates by adding important but often-ignored perspectives, namely, that of lived experience. Phenomenology focuses not on supposedly objective, scientifically validated facts, but on the "life world" of the individuals affected by a situation. Individuals' life worlds consist of their experience of their own lived bodies (or Leiber) and the meaning structures of their everyday worlds...
May 21, 2018: Hastings Center Report
Carolyn P Neuhaus
When President Obama laid out his vision for the U.S. Precision Medicine Initiative in a 2016 Boston Globe op-ed, he cautioned, "[I]t only works if we collect enough information first." "Collecting information" is an apt way to describe the subject of both books reviewed here. Jenny Reardon's The Postgenomic Condition: Ethics, Justice, and Knowledge after the Genome traces the history of the Human Genome Project and efforts around the globe to obtain blood samples to extract not only genetic data but also meaning from them...
May 2018: Hastings Center Report
(no author information available yet)
No abstract text is available yet for this article.
May 2018: Hastings Center Report
Jason Adam Wasserman, Mark Christopher Navin
When a patient lacks decision-making capacity, then according to standard clinical ethics practice in the United States, the health care team should seek guidance from a surrogate decision-maker, either previously selected by the patient or appointed by the courts. If there are no surrogates willing or able to exercise substituted judgment, then the team is to choose interventions that promote a patient's best interests. We argue that, even when there is input from a surrogate, patient preferences should be an additional source of guidance for decisions about patients who lack decision-making capacity...
May 2018: Hastings Center Report
Alex John London
Following a boom in investment and overinflated expectations in the 1980s, artificial intelligence entered a period of retrenchment known as the "AI winter." With advances in the field of machine learning and the availability of large datasets for training various types of artificial neural networks, AI is in another cycle of halcyon days. Although medicine is particularly recalcitrant to change, applications of AI in health care have professionals in fields like radiology worried about the future of their careers and have the public tittering about the prospect of soulless machines making life-and-death decisions...
May 2018: Hastings Center Report
Mark A Rothstein
May 21, 2018, marks the tenth anniversary of the signing into law of the Genetic Information Nondiscrimination Act. The Congressional deliberations for GINA were long and difficult. The original bill was introduced in 1995, and for many years, it did not look as if the bill would ever emerge from committee. Several of its provisions raised concerns for insurers, employers, and other stakeholders. After thirteen years, the controversial provisions were either deleted, revised, or clarified. At this ten-year mark, it is appropriate to take stock of GINA...
May 2018: Hastings Center Report
Nancy Berlinger
People who lack decision-making capacity may be able to communicate preferences, which can and should inform surrogate decision-making on their behalf. It is unclear whether making a further distinction about "capacity for preferences," as Jason Wasserman and Mark Navin propose in this issue of the Hastings Center Report , would improve the process of surrogate decision-making. Anyone who is regularly involved in surrogate decision-making or who has worked to articulate decision-making standards and processes can think of cases in which a patient's voice was ignored or his or her preferences and ability to communicate them overlooked...
May 2018: Hastings Center Report
Stephen R Latham
For the past few years I've had the distinct privilege to edit the Hastings Center Report's Policy & Politics column. The column-as indicated by a little block of text at its end-was originally conceived as, and remains, a joint production of HCR and the American Society for Bioethics and Humanities. For me, as column editor, this means that I can accept contributions only from ASBH members. Luckily this presents me with an extremely large pool of talent from which to draw! I am very proud of the fact that a large majority of contributors to the column in the last several years had never written in HCR before I invited them to contribute...
May 2018: Hastings Center Report
S Matthew Liao, Jordan Mackenzie
In "Genetic Privacy, Disease Prevention, and the Principle of Rescue," Madison Kilbride argues that patients have a duty to warn biological family members about clinically actionable adverse genetic findings. The duty does not stem from the special obligations that we may have to family members, she argues, but rather follows from the principle of rescue, which she understands as the idea that one ought to prevent, reduce, or mitigate the risk of harm to another person when the expected harm is serious and the cost or risk to oneself is sufficiently moderate...
May 2018: Hastings Center Report
Megan S Wright
In January 2016, Medicare began reimbursing clinicians for time spent engaging in advance care planning with their patients or patients' surrogates. Such planning involves discussions of the care an individual would want to receive should he or she one day lose the capacity to make health care decisions or have conversations with a surrogate about, for example, end-of-life wishes. Clinicians can be reimbursed for face-to-face explanation and discussion of care and advance directives and for the completion of advance care planning forms...
May 2018: Hastings Center Report
Laura Guidry-Grimes
In this issue of the Hastings Center Report, Jason Wasserman and Mark Navin argue that patients without decisional capacity can still have relatively stable wishes or inclinations toward one treatment option over another and that these preferences are "not devoid of moral weight and might therefore guide or at least influence treatment decisions when they cannot be defeated by other considerations." This position is not controversial among most bioethicists. The hard work comes in sussing out the details of this position...
May 2018: Hastings Center Report
Laura Haupt
Two articles in this issue of the Hastings Center Report (May-June 2018) argue that having knowledge of genetic mutations can entail a moral responsibility to rescue others. In the lead article, Madison Kilbride, a philosopher at the Perelman School of Medicine, assigns to the patient, under certain conditions, a task physicians are prohibited from taking on without patient consent: to disclose a finding of a serious, clinically actionable genetic mutation to the patient's relatives who are likely to have the same mutation...
May 2018: Hastings Center Report
Haley K Sullivan, Benjamin E Berkman
Much new global genetic research employs whole genome sequencing, which provides researchers with large amounts of data. The quantity of data has led to the generation and discovery of more incidental or secondary findings and to vigorous theoretical discussions about the ethical obligations that follow from these incidental findings. After a decade of debate in the genetic research community, there is a growing consensus that researchers should, at the very least, offer to return incidental findings that provide high-impact, medically relevant information, when it is not unduly burdensome to the research enterprise to do so...
May 2018: Hastings Center Report
Madison K Kilbride
Suppose that you have deeply personal information that you do not want to share. Further suppose that this information could help others, perhaps even saving their lives. Should you reveal the information or keep it secret? With the increasing prevalence of genetic testing, more and more people are finding themselves in this situation. Although a patient's genetic results are potentially relevant to all her biological family members, her first-degree relatives-parents, children, and full siblings-are most likely to be affected...
May 2018: Hastings Center Report
Gilbert Meilaender
Anyone who has paid attention to the work of Leon Kass over the years is likely to have read earlier versions of many of the essays collected in Leading a Worthy Life: Finding Meaning in Modern Times. Even so, they will repay repeated readings, if only because they are evidence that one who has spent his life in the academy can write prose that is clear, readable, and often arresting. Moreover, the essays, taken as a whole, exemplify nicely, as Kass puts it, "the two major activities of my professional life"-namely, "examining closely the human meaning of the new biology" and "teaching searchingly great books that offer profound but competing accounts of the good life" (p...
May 2018: Hastings Center Report
Daniel Eison
The oncology floor can be a silent place. Unlike the cardiology floor, with its insistent telemetry beeping, or the incessant bustle of the general ward below. Silence can be healing, and the oncology floor reveres all forms of healing it can find. Yet some voices ring loud on this floor. As an intern, I would grimace into my scut list as oncology attendings intoned dire diagnoses and exhorted still-reeling victims to altruistically enroll in clinical trials. I mutely ground my teeth listening to the relentless stream of probabilities and adverse reactions flooding into the shocked silence of a child baffled by his or her metamorphosis into a cancer patient between breakfast and lunch...
May 2018: Hastings Center Report
Douglas Mackay
In a carefully argued article, Haley K. Sullivan and Benjamin E. Berkman address the important question of whether investigators have a duty to report incidental findings to research participants in low-resource settings. They suggest that the duty to rescue offers the most plausible justification for the duty to return incidental findings, and they explore the implications of this duty for the context of research in low-resource settings. While I think they make valuable headway on an important problem, in this commentary, I identify a significant difference between the paradigmatic rescue case and the return of incidental findings in low-resource settings...
May 2018: Hastings Center Report
(no author information available yet)
Bioethics comes in for furious criticism in Stephen Pinker's new book, Enlightenment Now. Pinker argues that scientists are making human lives better and better, and that lives would get still better even faster if bioethicists did not use ideas like informed consent, dignity, sacredness, and social justice to hobble the scientists. Daniel Callahan, a cofounder of The Hastings Center and arguably of bioethics, is perhaps the best living embodiment of a bioethicist who has written about medical progress, and the March-April 2018 issue of the Hastings Center Report turns to him for a review of Pinker's book...
March 2018: Hastings Center Report
G Owen Schaefer, Julian Savulescu
During the course of biomedical research, researchers sometimes obtain information on participants that is outside the aim of the study but may nonetheless be relevant to the participants. These incidental findings, as they are known, have been the focus of a substantial amount of discussion in the bioethics literature, and a consensus has begun to emerge about what researchers should do in light of the possibility of incidental findings. A consensus, however, is not necessarily correct. In this article, we address the common view that reporting of incidental findings should be based primarily on the possibility of medical benefit, factoring in the findings' validity, clinical actionability, and significance to health or reproduction...
March 2018: Hastings Center Report
Sean Philpott-Jones
In the wake of the Stoneman Douglas School shooting, Republican and Democratic leaders-like the American electorate they represent-remain sharply divided in their responses to gun violence. They are united in their condemnation of these mass shootings, but they disagree about whether stricter or looser gun control laws are the answer. Those on the right side of the political aisle suggest that the issue is one of mental illness rather than gun control. Conversely, those who are more liberal or progressive in their political learnings are quick to condemn attempts to reframe the issue of mass shootings as a mental health problem...
March 2018: Hastings Center Report
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