Several authors have argued that act–utilitarianism cannot provide an adequate critique of buying meat because a single meat purchase will not actually cause more farm animals to be raised or slaughtered. Thus, regardless of whether or not the production of meat is inhumane to animals, someone who buys meat is doing nothing wrong. This argument fails to show that meat purchases are morally permissible, however, because it assumes that act–utilitarians would use actual utility in their decision to buy or not (...) to buy meat. I show that act–utilitarians cannot use actual utility as a decision procedure and must instead use expected utility to prescribe or proscribe actions. I then demonstrate how expected utility can be applied to cases of contributory causation, where many people seem morally responsible for causing something to happen. Buying meat is one case of contributory causation where the probability of any single individual's affecting meat production is slight, but the expected disutility of affecting that production is substantial. Thus, in its expected utility form, act–utilitarianism defeats the ‘causal inefficacy’ defence of buying meat [1]. (shrink)

Few moral arguments have been made against vegetarian diets. One exception is the “Logic of the Larder:” We do animals a favor by purchasing their meat, eggs, and milk, for if we did not purchase these products, fewer animals would exist. This argument fails because many farm animals have lives that are probably not worth living, while others prevent a significant number of wild animals from existing. Even if this were not so, the purchase of animal products uses resources that (...) could otherwise be used to bring a much greater number of animals into existence. (shrink)

Health care institutions have paid increasing attention to preventing nosocomial transmission of influenza through vaccination of health care personnel. While multifaceted voluntary interventions have increased vaccination rates, proponents of mandatory programs contend the rates remain unacceptably low. Conventional bioethical analyses of mandatory programs are inadequate; they fail to account for the obligations of nonprofessional personnel or to justify the weights assigned to different ethical principles. Using an ethics framework for public health permits a fuller analysis. The framework's focus on fairness (...) accentuates the potential differences between the risk of transmitting infection and employment status, and the need to equitably evaluate exemptions. The framework's emphasis on balancing benefits and burdens highlights the need to justify a specific goal and questions the need to exclude all nonmedical exemptions. While mandatory vaccination programs are justifiable, greater attention should be paid to their implementation. (shrink)

In this century a number of events could extinguish humanity. The probability of these events may be very low, but the expected value of preventing them could be high, as it represents the value of all future human lives. We review the challenges to studying human extinction risks and, by way of example, estimate the cost effectiveness of preventing extinction-level asteroid impacts.

IntroductionClassifying the ethical issues in clinical ethics consultations is important to clinical practice and scholarship. We conducted a systematic review to characterize the typologies used to analyze clinical ethics consultations.MethodsWe identified empirical studies of clinical ethics consultation that reported types of ethical issues using PubMed. We screened these articles based on their titles and abstracts, and then by a review of their full text. We extracted study characteristics and typologies and coded the typologies.ResultsWe reviewed 428 articles; 30 of the articles (...) fulfilled our inclusion criteria. We identified 27 unique typologies. Each typology contained five to 47 categories (mean = 18). The most common categories were do-not-attempt-resuscitation orders (19 typologies, 70 percent), capacity (18 typologies, 67 percent), withholding (18 typologies, 67 percent), withdrawing (17 typologies, 63 percent), and surrogate or proxy (16 typologies, 59 percent). Only seven (26 percent) of the typologies contained all five of the most common categories. The typologies we used to characterize clinical ethics consultations exhibit significant heterogeneity and several conceptual limitations. A common typology is needed whose development may require multi-institutional collaboration and could be facilitated by professional organizations. (shrink)

Staff at Cincinnati Children’s Hospital Medical Center used behavior contracts to address “difficult” patients and families for years. Nonadherence with recommended medical treatments was generally...

The American Medical Association opinion “Physician Exercise of Conscience” is generally sound; its recommendations regarding notice, nondiscrimination, informed consent, referral, and non-abandonment are reasonable. Within its focus on individual physicians’ duties to particular patients, it could also emphasize that physicians should only share the reasons for their objections if patients express an interest and that they should only share the reasons in a respectful manner. The opinion, however, neglects wider time frames and higher levels of organization. It could comment on (...) physicians’ duty to form their consciences appropriately and to select specialities and practice settings that do not engender excessive conflicts. Given the number of physicians who are not self-employed and the role of law in establishing rights and responsibilities, the opinion could also address employers’, legislatures’, and courts’ obligations to balance protecting physicians’ integrity and assuring patients’ access to medical treatment. Addressing these wider perspectives would greatly strengthen the opinion. (shrink)

Michael Potts, Paul A. Byrne, an David W. Evans are critical of donation after cardiac death (DCD). Contrary to the authors’ assertion that the removal of vital organs is the proximate cause of death, the eventual fulfillment of the neurological criteria of death is solely dependant on the rate of brain cell death in the absence of circulation. Consistent with the “dead donor rule,” DCD is not the cause of death. There are also procedural mechanisms to address the potential conflicts (...) of interest that concern the authors. Rather than being prohibited, DCD may be an ethically justifiable exception to the rule that organ donors must be dead prior to organ recovery. (shrink)

Many academic medical centers are seeking to attract patients from outside their historical catchment areas for economic and programmatic reasons, and patients are traveling for treatment that is unavailable, of poorer quality, or more expensive at home. Treatment of these patients raises a number of ethical issues including whether they may be given priority in scheduling outpatient follow-up appointments in order to reduce the period of time they are away from home. Granting them priority is potentially unjust because medical treatment (...) is generally allocated based on medical need and resource utilization, and then on a first-come, first-served basis. While it is difficult to compare the opportunity cost of waiting for an appointment to different patients, nonresident patients incur higher expenditures for travel, room, and board than resident patients. Giving them priority in scheduling to reduce these costs may be justifiable. Preferentially scheduling nonresident patients may also indirectly benefit resident patients consistent with Rawls’s difference principle. This potential justification, however, rests on several empirical claims that should be demonstrated. In addition to reducing resident patients’ waiting times, medical centers should not prioritize nonresident patients over resident patients with more urgent medical needs. There is, therefore, a limited and circumscribed justification for prioritizing nonresident patients in scheduling follow-up appointments. (shrink)

Volume 20, Issue 7, July 2020, Page 133-135.

Critical reflection on clinical ethics consultation is essential to the field. Johnson and colleagues (2015) have helpfully summarized the consultation experience of a children's specialty hospital...

Health care institutions have paid increasing attention to preventing nosocomial transmission of influenza through vaccination of health care personnel. While multifaceted voluntary interventions have increased vaccination rates, proponents of mandatory programs contend the rates remain unacceptably low. Conventional bioethical analyses of mandatory programs are inadequate; they fail to account for the obligations of nonprofessional personnel or to justify the weights assigned to different ethical principles. Using an ethics framework for public health permits a fuller analysis. The framework's focus on fairness (...) accentuates the potential differences between the risk of transmitting infection and employment status, and the need to equitably evaluate exemptions. The framework's emphasis on balancing benefits and burdens highlights the need to justify a specific goal and questions the need to exclude all nonmedical exemptions. While mandatory vaccination programs are justifiable, greater attention should be paid to their implementation. (shrink)

Volume 20, Issue 6, June 2020, Page 25-27.

The American Society for Bioethics and Humanities debated for several years about whether it should adopt positions and, if so, on what range of issues. The membership recently approved an amendment to its bylaws permitting the Society to adopt positions on matters related to academic freedom and professionalism but not on substantive moral and policy issues. This resolution is problematic for a number of reasons, including the lack of a categorical difference between these types of claims and the Society's inability (...) to speak on behalf of patients and research subjects. The implementation of the amendment also raises several issues. The Society will need to refrain from speaking too specifically and to articulate the responsibilities of its members. If the Society fails to address these concerns, it runs the risk of denigrating its public image and that of the profession. (shrink)

Volume 20, Issue 3, March 2020, Page 1-5.

The analysis of a dispute can focus on either interests, rights, or power. Commentators often frame the conflict over conscience in clinical practice as a dispute between a patient’s right to legally available medical treatment and a clinician’s right to refuse to provide interventions the clinician finds morally objectionable. Multiple sources of unresolvable moral disagreement make resolution in these terms unlikely. One should instead focus on the parties’ interests and the different ways in which the health care delivery system can (...) accommodate them. In the specific case of pharmacists refusing to dispense emergency contraception, alternative systems such as advanced prescription, pharmacist provision, and over-the-counter sales may better reconcile the client’s interest in preventing unintended pregnancy and the pharmacist’s interest in not contravening his or her conscience. Within such an analysis, the ethicist’s role becomes identifying and clarifying the parties’ morally relevant interests. (shrink)

Nonpharmaceutical interventions to minimize the transmission of the severe acute respiratory syndrome coronavirus 2 are necessary because we currently lack a vaccine or specific treatments. Healthcare facilities have adopted visitor restrictions and masking requirements. These interventions should be evaluated as public health measures, focusing on their efficacy, the availability of less-restrictive alternatives, and the minimization of the burdens and their balance with the benefits. These interventions, as well as exceptions, can be justified by the same analysis. For example, visitor restrictions (...) are sound, as are exceptions for women in labor, adults with disabilities, minor children, and individuals who are dying. In implementing these policies, specific rules are preferable to general principles because they are more efficient and reduce possible bias. There should, however, be appeal mechanisms and retrospective review processes. Evaluating requests for medical exemptions to masking requirements is particularly difficult, given the prevalence of nonmedical objections, false claims of medical exemptions, and a lack of objective medical criteria. Requiring written statements by licensed healthcare providers that undergo subsequent substantive review may therefore be justified. (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page 11-13, August 2012.

In this case, an adolescent with a life-threatening immune disease experiences increased social complexity, child welfare involvement, and placement into foster care, which could disrupt a medical...

(Statement of Responsibility) by Timothy S. Huebner.

International child rights law has the potential to change the way children are viewed and engaged by all social actors. It provides a child-centered perspective on all areas of children’s lives, including research with neonates. It differs from some bioethical perspectives by clearly articulating affirmative obligations owed to children and requiring rigorous monitoring mechanisms. The CRC’s focus on affirmative obligations and establishment of monitoring mechanisms provide additional useful elements that are not present in the dominant form of American pediatric bioethics.An (...) in-depth introduction to child rights and the U.N. Convention on the Rights of the Child is presented by Lansdown.. (shrink)

Of the different features of this case, I focus on the pediatric endocrinologist's refusal to treat the patient. Providers generally have wide latitude in accepting or refusing patients. Appropriat...

Of the different features of this case, I focus on the pediatric endocrinologist's refusal to treat the patient. Providers generally have wide latitude in accepting or refusing patients. Appropriat...

: The film "Who Should Survive?: One of the Choices on Our Conscience" contains a dramatization of the death of an infant with Down syndrome as the result of the parents' decision not to have a congenital intestinal obstruction surgically corrected. The dramatization was based on two similar cases at The Johns Hopkins Hospital and was financed by the Joseph P. Kennedy, Jr., Foundation. When "Who Should Survive?" was exhibited in 1971, the public reaction was generally critical of the parents' (...) decision and the physicians' inaction. Although technological developments in medicine were a necessary condition for the production of this film and its unanticipated reception, they were not a sufficient condition. The proximate cause was a changed understanding of the capabilities of individuals with Down syndrome. Part of the impetus for this change was data showing the adverse effects of institutionalization on normal children. (shrink)

Bioethicists have scrupulously defended patients’ privacy and autonomy in medical care settings; they have not always taken the same care in their own work.

In Disability's Challenge to Theology: Genes, Eugenics, and the Metaphysics of Modern Medicine (Notre Dame Press, 2022), Devan Stahl establishes an ambitious goal: develop a Christian bioethics that is metaphysically grounded, informed by the experience of disability, and culturally compelling. She argues that personhood is not the possession of certain abilities; all humans are worthy of dignity and respect because they are created by God in God's image. According to Stahl, persons should be valued for who they are and treated (...) with radical acceptance. Interventions on the body should be judged on whether they promote flourishing, and such judgments should be informed by the experience of disability and made in community. These arguments will be of interest to Christian bioethics, disability scholars, and those interested in the capability approach, but clinical ethicists may find Stahl's book less compelling. (shrink)

Background: While employers are increasingly considering and implementing COVID-19 vaccination requirements, little is known about the reasons offered by employees seeking religious exemptions.Methods: We conducted a mixed methods analysis of all the requests for religious exemptions submitted during the initial implementation of a COVID-19 vaccination requirement at a single academic medical center in the United States.Results: Five hundred sixty-five (3.4%) employees requested religious exemptions. At least 305 (54.0%) requesters had job titles suggesting that they had direct patient contact. Four hundred (...) ninety-nine (88.3%) of requesters self-identified as Christian, of whom 120 (21.2%) identified as Roman Catholic. Requesters offered 0 to 8 (mean 2.7) categories of reasons for their request. The most frequently stated reasons pertained to the use of fetal cell lines in vaccine development and manufacturing (382, 67.6%), interest in maintaining purity (221, 39.1%), or belief in divine healing (172, 30.4%). Some requesters also volunteered evidence of the sincerity of their beliefs including examples of their religious practices (116, 20.5%), other practices (66, 11.7%), and emotional states (32, 5.7%). One hundred fifty-two applications (26.9%) contained text copied without attribution, primarily from sample religious exemption request letters available on the Internet.Conclusions: Most requesters focused on the use of fetal cell lines in the development or manufacturing of the vaccines as the justification for their request. The development of vaccines that are not reliant on fetal cell lines may increase vaccination rates. Understanding reasons for religious exemption requests may inform vaccine education and vaccination policies. (shrink)