This book systematically reviews a variety of methods for addressing ethical problems in medicine, accounting for both their weaknesses and strengths. Illustrated throughout with specific cases or controversies, the book aims to develop an informed eclecticism that knows how to pick the right tool for the right job.

Professor Cole is correct in his conclusion that the University of Pittsburgh Medical Center (UPMC) protocol does not violate requirements of "irreversibility" in criteria of death, but wrong about the reasons. "Irreversible" in this context is best understood not as an ontological or epistemic term, but as an ethical one. Understood that way, the patient declared dead under the protocol is "irreversibly" so, even though resuscitation by medical means is still possible. Nonetheless, the protocol revives difficult questions about our concept (...) of death. (shrink)

The research importance of biobanked biological materials and their derived data is growing, especially as these are increasingly linked with individual and population‐level medical and health information. The number, diversity, and size of biobanks are growing in tandem. So, too, is the number of individuals whose donations are being used in biobank‐supported research, with or without their knowledge. Pretty soon, we all will be “participants” in a variety of research projects we know nothing about. Until recently, our leftover tissue or (...) deidentified medical information could be used for research without our consent or even our knowledge. Even if we've been asked–as the current regulations require when research uses are anticipated‐we were most likely asked to give a blanket consent to any future use, with no prospect of learning about or controlling how our material is later used. This is an ethically problematic state of affairs, but there are options for improving it. (shrink)

Bioethicists appearing in the media have been accused of "shooting from the hip" (Rachels, 1991). The criticism is sometimes justified. We identify some reasons our interactions with the press can have bad results and suggest remedies. In particular we describe a target (fostering better public dialogue), obstacles to hitting the target (such as intrinsic and accidental defects in our knowledge) and suggest some practical ways to surmont those obstacles (including seeking out ways to write or speak at length, rather than (...) in sound bites). We make use of our own research into the way journalists quote bioethicists. We end by suggesting that the profession as a whole look into this question more fully. (shrink)

Book reviewed in this article: Life and Death: Philosophical Essays in Biomedical Ethics. By Dan W. Brock.

Donors to biobanks are typically asked to give blanket consent, allowing their donation to be used in any research authorized by the biobank. This type of consent ignores the evidence that some donors have moral, religious, or cultural concerns about the future uses of their donations – concerns we call “non-welfare interests”. The nature of non-welfare interests and their effect on willingness to donate to a biobank is not well understood. In order to better undersand the influence of non-welfare interests, (...) we surveyed a national sample of the US population using a probability-based internet panel. Logistic regression models assessed the demographic and attitudinal characteristics associated with participants’ willingness to give consent for unspecified future uses of their donation when presented with 7 research scenarios that raised possible non-welfare interest concerns. Most people had non-welfare interests that significantly affect their willingness to donate to a biobank using blanket consent. Some non-welfare interests are associated with subgroups but others are not. A positive attitude toward biomedical research in general was associated with increased willingness to donate, while concerns about privacy and being African American were associated with decreased willingness. Non-welfare interests matter and can diminish willingness to donate to a biobank. Our data suggest that trust in research promotes willingness to donate. Ignoring non-welfare interests could erode this trust. Donors’ non-welfare interests could be accommodated through greater transparency and easier access to information about the uses of donations. (shrink)

For a number of reasons, casuistry has come into vogue in medical ethics. Despite the frequency with which it is avowed, the application of casuistry to issues in medical ethics has been given virtually no systematic defense in the ethics literature. That may be for good reason, since a close examination reveals that casuistry delivers much less than its advocates suppose, and that it shares some of the same weaknesses as the principle-based methods it would hope to supplant.

Hospital futility policies are ethically defensible, but they require the proper understanding of futility and should be embedded in a larger process for making decisions about limiting treatment.

Volume 20, Issue 9, September 2020, Page 29-31.

The whole brain-death criterion of death now enjoys a wide acceptance both within the medical profession and among the general public. That acceptance is in large part the product of the contention that brain death is the proper criterion for even a conservative definition of death – the irreversible loss of the integrated functioning of the organism as a whole. This claim – most recently made in the report of the Presidential Commission and in a comprehensive article by James Bernat (...) and others – is based upon a series of fallacious arguments. Chief among these is the argument that whole brain-death is the proper criterion for the conservative definition because the brain is the organ that integrates the rest of the organism. A central part of the paper shows that this argument rests upon a confusion between a function and the mechanism that performs it, and replies to the defenses that the Presidential Commission makes on this point. The concluding portion of the paper argues that this issue is not merely of academic interest, but has the potential for undermining the present consensus that supports the use of whole brain-death criteria. * Keywords: brain-death, definition of death, determination of death * I would like to thank Howard Brody and Bruce Miller for helpful suggestions and criticisms. CiteULike Connotea Del.icio.us What's this? (shrink)

In the latest edition of Principles of Biomedical Ethics, Tom Beauchamp and James Childress provide an expanded discussion of the ethical theory underlying their treatment of issues in medical ethics. Balancing judgements remain central to their method, as does the contention that such judgements are more than intuitive. This theory is developed precisely in response to the common skepticism directed at "principlism" in medical ethics. Such skepticism includes the claim that moral reasoning comes to a dead halt when confronted by (...) competing conflicts between moral norms in a given pluralistic situation. In this paper, I use examples from the text to show that despite the authors’s arguments to the contrary, balancing judgements are the product of unreasoned intuitions. Given the necessity of some such judgements in any principle-based system, my argument highlights the degree to which principled ethical reasoning rests upon an arational core. (shrink)

Like many other bioethicists, I often give talks on clinical topics that may touch on the patient's right of autonomy with regard to medical treatment and, from there, may move to questions about whether said patient has the capacity to exercise said right. When I get to that subject, I might ask, “Is this person competent to refuse treatment?” A stunned silence falls over the room, until finally a hand shoots up. “‘Competent’ is a legal term,” I am instructed. “Don't (...) you mean to ask whether he has the capacity to make decisions for himself?” The tone suggests that I'm being helped to make a very important distinction. But it's not a very important distinction; and it's misleading to boot. (shrink)

Contrary to the revised Common Rule, and contrary to the views of many bioethicists and researchers, we argue that broad consent should be sought for anticipated later research uses of deidentified biospecimens and health information collected during medical care. Individuals differ in the kinds of risk they find concerning and in their willingness to permit use of their biospecimens for future research. For this reason, asking their permission for unspecified research uses is a fundamental expression of respect for them as (...) persons and should be done absent some compelling moral consideration to the contrary. We examine three moral considerations and argue that each of them fails: that there is a duty of easy rescue binding on all, that seeking consent creates a selection bias that undermines the validity of biospecimen research, and that seeking and documenting consent will be prohibitively expensive. (shrink)

A response to commentaries by David Wendler and by Bartha M. Knoppers, Edward S. Dove, and Ma'n H. Zawati on “Respecting Donors to Biobank Research,” from the January‐February 2013 issue.

For methodological or other legitimate reasons it may sometimes be advantageous to withhold an incentive from research participants who don’t meet certain conditions. This commentary describes a case in which the researchers propose such a plan. The IRB reviewers object to the plan, claiming that it exacts a penalty against participants’ right to withdraw, and that it exerts an undue influence on their continued participation. Each of these arguments is critically evaluated and found unpersuasive.

The capacity to designate a surrogate is not simply another kind of medical decision-making capacity. A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patients who lack DMC (...) for many or most kinds of medical choices may nonetheless possess the CDS, particularly since the complex means-ends reasoning required by DMC is one of the first capacities to be lost in progressive cognitive diseases. That is, patients with significant cognitive decline or mental illness may still understand what a surrogate does, express a preference about a potential surrogate, and be able to provide some kind of justification for that selection. Moreover, there are many legitimate and relevant rationales for surrogate selection that are inconsistent with the reasoning criterion of DMC. Unfortunately, many patients are prevented from designating a surrogate if they are judged to lack DMC. When such patients possess the CDS, this practice is ethically wrong, legally dubious and imposes avoidable burdens on healthcare institutions. (shrink)

The primary goal of ethics consultation should be to provide effective assistance to patients and families in obtaining care that is duly responsive to their rights and their needs. The consultation reported by Mark Bliton fails in this regard because it never ascertains why the consultation was called; makes little attempt to ascertain the motives of those involved; avoids exploration of the ethical concerns of family, attending or staff; makes no connection with institutional policies or practices; uncritically adopts and serves (...) the medical treatment ethos; and substitutes fellowfeeling for compassionate action. (shrink)

Book reviewed in this article: Life and Death: Philosophical Essays in Biomedical Ethics. By Dan W. Brock.

The New Medicine and the Old Ethics. By Albert R. Jonsen.

More than twenty years after its original publication, The Case for Animal Rights is an acknowledged classic of moral philosophy, and its author is recognized as the intellectual leader of the animal rights movement. In a new and fully considered preface, Regan responds to his critics and defends the book's revolutionary position.

To understand Self-Representationalism you need to understand its family. Self-Representationalism is a branch of the Meta-Representationalist family, and according to theories in this family what distinguishes conscious mental representations from unconscious mental representations is that conscious ones are themselves the target of a mental meta¬-representational state. A mental state M1 is thus phenomenally conscious in virtue of being suitably represented by some mental state M2. What distinguishes the Self-Representationalist branch of the family is the claim that M1 and M2 must (...) be the same token mental state, so a mental state is phenomenally conscious in virtue of suitably representing itself. This Self-Representationalist branch of the family divides into further branches, giving us specific implementations of the Self-Representationalist approach. But before asking whether we should adopt Self-Representationalism, and in what form, we should reflect on why Meta-Representationalism is an attractive family in the first place. After all, Self-Representationalist theories trade on their family name, claiming to deliver on the promises that drive the Meta-Representationalist approach. The two most important promises of Meta-Representationalism are: a) the promise of capturing the transitivity of consciousness and; b) the promise of rendering consciousness naturalisable. I discuss each in turn. (shrink)

If we were to connect two individuals’ brains together, how would this affect the individuals’ conscious experiences? In particular, it is possible for two people to share any of their conscious experiences; to simultaneously enjoy some token experiences while remaining distinct subjects? The case of the Hogan twins—craniopagus conjoined twins whose brains are connected at the thalamus—seems to show that this can happen. I argue that while practical empirical methods cannot tell us directly whether or not the twins share conscious (...) experiences, considerations about the locality of content processing in the brain entails that they most likely do so. (shrink)

Abstract Temporal Externalism is the view that future events can contribute to determining the present content of our thoughts and utterances. Two objections to Temporal Externalism are discussed and rejected. The first is that Temporal Externalism has implausible consequences for the epistemology of biology and other taxonomic sciences (Brown, 2000). The second is that it is committed to implausible claims about dispositions.

It is an important feature of creatures like us that our various motivations compete for control over our behaviour, including mental behaviour such as imagining and attending. In large part, this competition is adjudicated by the stimulation of affect — the intrinsically pleasant or unpleasant aspects of experience. In this paper I argue that the motivation-affect system controls a sub-type of attention called 'alerting attention' to bring various goals and stimuli to consciousness and thereby prioritize those contents for action. This (...) view allows me to flesh out the global workspace theory of consciousness, as well as some of the phenomenal characteristics of conscious experience. (shrink)

How wrong is it to deceive someone into sex by lying, say, about one's profession? The answer is seriously wrong when the liar's actual profession would be a deal breaker for the victim of the deception: this deception vitiates the victim's sexual consent, and it is seriously wrong to have sex with someone while lacking his or her consent.

Over the course of its first seven editions, Principles of Biomedical Ethics has proved to be, globally, the most widely used, authored work in biomedical ethics. It is unique in being a book in bioethics used in numerous disciplines for purposes of instruction in bioethics. Its framework of moral principles is authoritative for many professional associations and biomedical institutions-for instruction in both clinical ethics and research ethics. It has been widely used in several disciplines for purposes of teaching in the (...) classroom, during conferences, etc. (shrink)

In this paper, I argue against recent modifications of the Knowledge Condition on intentional action that weaken the condition. My contention is that the condition is best understood in the context of Anscombe’s Intention and, when so understood, can be maintained in its strongest form.