Hastings Center Report

A few weeks ago, on a beautiful Saturday morning, I found myself lying on a bed in an emergency room with tenderness in my stomach that I thought might indicate appendicitis. The physician who saw me was efficient and friendly and, as near as I am able to tell, gave me good care. When I described my symptoms, however, something I said caused him to smirk a little and remark disapprovingly, "Aha. You've been on the Internet, haven't you?" I had, and now I was embarrassed. "Oh, well, yeah, a little bit."

In retrospect, I thought, "Of course I was on the Internet. What sane, educated person with limited medical knowledge but easy access to the Internet would not go there to check out a worrisome symptom?" I was put in mind of a recent article in the Report about how the widespread availability of medical information (some of it garbage, of course) is changing or should change the doctor-patient encounter.

As it turns out, that article exemplifies a trend. I have just learned that we published several pieces this year about the interpersonal dynamics of the doctor-patient encounter. I might have been expected to know this already, but in fact, I know it because I have just spent some hours drawing up the Report's annual index—a tedious task that nonetheless often generates some spark of insight. It illuminates how editorial content shifts from year to year.

In this past year, the Report touched on genetics, cloning, and enhancement only indirectly, through book reviews or essays on the general topic of regulations for biotechnologies. We published several pieces on how doctors deal with difficult patients, and an assortment of pieces on how doctors should talk to surrogate decision-makers about "futile" care. We also published quite a bit about governance, including not only the regulation of technologies, but also health policy and issues of justice.

In turn, seeing how content has shifted always prompts us to ask how we want it to shift. Here, then, is a kind of editor's wish list:

1. •. Less about the field of bioethics. This wish may seem odd, as the current issue features some interesting pieces that comment on what bioethicists have been doing. What drew me to these pieces, however, was their conceptual or policy work; that material is interesting even outside bioethics.

2. •. More about the practice of medicine and debates over medical interventions. In 2006, we published a couple of essays on Avastin, another on medical marijuana, and a short commentary on the use of CT scans. I wish we had more such pieces. This kind of work can also look back: it can include discussion of what Daniel Callahan calls "second order problems"—the downstream consequences of older medical or biotechnological developments.

3. •. Less theory. A discussion of CT scans need not begin by explaining the four basic principles of bioethics, or how narrativism differs from principlism, or the virtue ethics approach to practical ethics. It's possible just to jump into the pros and cons.

4. •. More about health policy and public health issues.

5. •. Less in the way of blunt appraisal, and more in the way of recommendations. The standard dodge, of course, is to recommend further discussion, but to the extent one can go beyond that and outline practical advice—views you can use—so much the better.

I look forward to generating next year's index. [End Page 2]