The peer commentaries on our Target Article, “Promoting Ethical Payment in Human Infection Challenge Studies,” offer a number of insights that will help advance the co...

In this article, I defend a discomfiting thesis: The clinical ethicist should sometimes be an active participant in the deception of patients and families. The case for this conclusion builds off Sissela Bok’s seminal analysis of lying, from which I emphasize that, despite some common intuitions to the contrary, there is prima facie no morally relevant difference between lies of omission and commission. I then discuss deception’s prevalence in medical encounters, noting that the ethicist is often embedded in corresponding decisions, (...) and explicate the realities that underlie these tough cases. Among those realities is the fallacy that deception can always be avoided through better communication. I conclude with an elaboration of ethicists’ role-model status and argue that they can turn the deception into a powerful teaching moment about the complexity of ethics reasoning. (shrink)

Over the last few decades, multiple studies have examined the understanding of participants in clinical research. They show variable and often poor understanding of key elements of disclosure, such as expected risks and the experimental nature of treatments. Did the participants in these studies give valid consent? According to the standard view of informed consent they did not. The standard view holds that the recipient of consent has a duty to disclose certain information to the profferer of consent because valid (...) consent requires that information to be understood. The contents of the understanding and disclosure requirements are therefore conceptually linked. In this paper, we argue that the standard view is mistaken. The disclosure and understanding requirements have distinct grounds tied to two different ways in which a token of consent can be rendered invalid. Analysis of these grounds allows us to derive the contents of the two requirements. It also implies that it is sometimes permissible to enroll willing participants who have not understood everything that they ought to be told about their clinical trials. (shrink)

The events of 2020 have shaken the core of bioethics in a way that we hope will pave a new and equitable, though perhaps uncomfortable, path forward. We would like to thank those who responded to o...

In order to consider how best to address relationship concerns with potential research participants arising in this study, we will first describe unique features...

In their article “Racial Justice Requires Ending the War on Drugs,” Earp, Lewis, and Hart argue for the end of our War on Drugs in order to alleviate our reliance on mass incarceration, harm...

In her article, Lee vouches for a reciprocity-based approach that supports an ethics of inclusion in precision medicine research and accounts for participants’ values and experiences of the...

Precision medicine research involving human biological material is becoming an increasingly central component of healthcare, and its potential is quickly growing due to rapid technological progress...

Brian Earp and colleagues argue that the major harms associated with the use of illicit drugs largely arise from, or are at least exacerbated by, the fact that their use attracts criminal pe...

In “Obligations of the Gift,” Lee argues that ethical thinking regarding return of genetic research results has been too narrowly focused on individual consent and participants’ “right to kn...

One of the fundamental ethical ambiguities in giving over our information is that it allows the other party not just to help us better, but also to exploit us better. Today we are increasingly aware of this ambiguity wherever big data is used, and precision medicine is proving to be no exception. Here I sketch the role that status hierarchies play in the relation between researchers and research subjects.

Historically, laws and policies to criminalize drug use or possession were rooted in explicit racism, and they continue to wreak havoc on certain racialized communities. We are a group of bioethicists, drug experts, legal scholars, criminal justice researchers, sociologists, psychologists, and other allied professionals who have come together in support of a policy proposal that is evidence-based and ethically recommended. We call for the immediate decriminalization of all so-called recreational drugs and, ultimately, for their timely and appropriate legal regulation. We (...) also call for criminal convictions for nonviolent offenses pertaining to the use or possession of small quantities of such drugs to be expunged, and for those currently serving time for these offenses to be released. In effect, we call for an end to the “war on drugs.”. (shrink)

Lee suggests a conceptualization of health data sharing not merely as an act of altruism, but as a gift. The difference is important, as the inscription of the latter in a social context inv...

In “Racial Justice Requires Ending the War on Drugs,” Earp and colleagues argue that the personal use or possession of all currently illicit psychoactive substances should be immediately decriminal...

In “Obligations of the ‘Gift’: Reciprocity and Responsibility in Precision Medicine,” Lee rightly points out that disparities in health care access also lead to disparities in precision medi...

Traditional approaches to human subjects protections in the United States focus on the ethical principles from the Belmont Report: respect for persons, beneficence, and justice. Since research regu...

Biomedical research and its translation continue to pose normative questions about the nature of relations between researcher and participant and the role of research involving human subjects in so...

As medicine and science advance, new ethical questions emerge. Over time, deliberation and analysis result in a somewhat settled approach to a problem. Often the settled approach is based on group...

Earp, Lewis, and Hart argue the pursuit of racial justice requires a summary end to the war on drugs. In surveying the racially disparate harms of an enforcement-oriented, punitive, and ulti...

Ethical issues in biomedical research are traditionally examined as distinct from those of clinical care. However, this traditional framing may obscure questions of equity and fairness in both rese...

Ethical issues in biomedical research are traditionally examined as distinct from those of clinical care. However, this traditional framing may obscure questions of equity and fairness in both rese...

In “Obligations of the Gift” Sandra Lee suggests that social norms of reciprocity and the expectations and obligations associated with gift-giving afford a framework for addressing social ju...

Achieving valid informed consent from a human research participant involves an ongoing process designed to protect the participant and ensure their rights, safety, and well-being are not compromise...

Gifts have served as a fundamental aspect of the human experience across time, even as their precise roles and functions have shifted. In the past, bioethicists and others have drawn upon anthropol...

Lee emphasizes the need to better understand the moral relationship between researchers and participants connoted by precision medicine, with the framework of “the gift” offering bioethics a...

In this case, it is noted that while DNA testing and methylation are being studied as biomarkers for high-grade squamous intraepithelial lesions in the anal canal, their efficacy is no...

Earp, Lewis, and Hart write about the racism entrenched in policies criminalizing drug use and possession and describe the disparate impact that these policies have on certain racialized com...

The paper by Earp, Lewis, and Hart offers a strong criticism of the so-called “war on drugs.” The authors very convincingly argue that the war “has worsened many aspects of public health whi...

The United States’ long-running “War on Drugs” has been a dramatic failure. By adopting a punitive mindset centered on prohibition, government officials have demonstrated that control—not public he...

Earp et al. provide a robust justification for the decriminalization of drugs based on the systemic racism that fuels the “war on drugs” and the ongoing harms of drug policies to individuals...

Even appropriate, ethically sound recommendations can generate angst. In this case, the principal investigator is concerned about the ethics consult recommendation to not inform the participan...

Earp and colleagues make a strong case for the complete decriminalization and even the legalization of recreational drug use based on the negative impact of the “War on drugs” on racialized...

Drug enforcement is unattractive, to put it mildly, particularly in the United States. Few try to defend current U.S. policies, let alone those from before recent reforms.The Bureau of Justice Stat...

Brian Earp and his colleagues argue in this issue’s target article that racial justice requires ending the War on Drugs. In this they are absolutely correct. Indeed, de...

“Racial Justice Requires Ending the War on Drugs” is an impressively well evidenced argument for the need for drug reform. The authors outline how the war on drugs caus...

Earp, Lewis, and Hart make a comprehensive and compelling argument for ending the “war on drugs,” highlighting the importance of both ending the criminalization of people who use drugs, and...

What do certain military missions in Afghanistan, domestic spying in the United States, therapeutic interventions in Russia and Denmark, torture and rape in an Indonesian police station, and Stop a...

In the target article “Promoting Ethical Payment in Human Infection Challenge Studies,” Fernandez Lynch et al. call for more information sharing about research payment amounts to study parti...

Practitioners of bioethics engage in a wide range of endeavors from hospital-based clinical consultation to commentary in both academic and broader public forums. “Impact ethics” is either an orien...

Sabatello et al. make a compelling case for structural racism as the root cause of the health inequities experienced by communities of color during the COVID-19 pandemic. As public health pr...

The proposed framework by Lynch et al. for promoting ethical forms of payment in Human Infection Controlled Studies in general and SARS-Cov-2 HICS in particular is an important contri...

In their address of structural racism in healthcare, Sabatello and colleagues provide both a remarkable review of the empirical literature regarding the disproportionate impacts of the COVID...

Inequity has been a hallmark of the COVID-19 pandemic in the United States, especially in the sharply disproportionate impacts among people of color. Recent studies have confirmed that t...

Maya Sabatello and coauthors, in “Structural Racism in the COVID-19 Pandemic,” have called our attention to how preexisting systemic racism in the United States has produced exactly the racial disp...

Disparities in maternal morbidity and mortality for Latinx populations are a paradigmatic example of the now widely acknowledged structural racism in U.S. health care that predisposed minorities to...

The paper by Lynch et al. argues that payments to research participants in biomedical research can be divided into three different categories, reimbursement, compensation, and incentive and...

“Old Black Joe still picking cotton for your ribbons and bows. And everybody knows.” - Leonard Cohen, “Everybody Knows.” African-Americans and other minorities are suffering disproportionately duri...

To prepare for potential human infection challenge studies involving SARS-CoV-2, we convened a multidisciplinary working group to address ethical questions regarding whether and how much SAR...

In their Target Article, “Promoting Ethical Payment in Human Infection Challenge Studies,” Lynch et al. propose a framework for ethical payment to research participants and apply it to the c...

The COVID-19 pandemic has been unprecedented, in every sense of the word. At the time of writing, there have been nearly 80 million confirmed cases of coronavirus and nearly 2 million deaths worldw...

After the November 2020 U.S. presidential election, many political analysts looked at the voting patterns of Latinx communities with consternation and surprise. Some analysts noted that “Latinx” ha...

The Target Article by Sabatello et al. should prove significant in advancing recognition of, and discussion concerning how, race is embedded in allocation strategies adopted in pandemic resp...

This commentary shall focus on the central claim made in Lynch et al.’s paper “Promoting Ethical Payment in Human Infection Challenge Studies.” According to their paper, there is a threefold...

The paper by Lynch et al. raises interesting ethical questions regarding whether and how much SARS-CoV-2 Human Challenge Studies participants should be paid. We appreciate the timely e...

“Structural racism in the COVID-19 pandemic: moving forward” offers a nuanced and important critique of racial and ethnic health disparities starkly illuminated by COVID-19....

Paying research subjects for their participation in biomedical studies is an increasingly common and acceptable practice. Nevertheless, it continues to raise numerous conceptual, ethical, and pract...

There is asbestos under the eaves of my house, outside my bedroom and bathroom. Imagine I want to remove it. I know there is a danger with asbestos removal causing asbestosis and mesothelioma. I do...

Sometimes doing what’s right depends on anticipating how people will react when you do the right thing. Consider two aspects of challenge trial payments discussed by Lynch and colleagues. Th...

This commentary discusses how racism can be perpetuated in two of the areas discussed in Sabatello et al: research for identifying remedies and contact tracing. Racism is a social system where the...

Without proper recognition of the dual pandemics of COVID-19 and racism that Asian Americans and other racial minorities in the United States are facing, we cannot successfully address structural b...

COVID-19 vaccine research success and emergency use authorizations have shown the life sciences’ potential for positive health impact. But they also underscore potentially divergent and conf...

One of the central characteristics of public health disasters is the rapid overlapping of different needs and priorities that require making critical choices that inevitably elicit conflicti...

It is urgent that we address the causes and harmful effects of racism in health care. We propose that building diversity competence in the way we deliver health care services is key to this effort....

Black women and their babies matter. In this commentary, we explore the current challenges that Black women face when pregnant and what is needed to ensure an anti-racist approach to prenatal and p...

In this commentary, we take up Yearby’s call for racism-sensitive research and apply this to the discourse regarding race and diversity in COVID vaccine research. We consider whether efforts...

Bioethicists in healthcare institutions have the skills and insights and can and must facilitate and promote measures that address deeply ingrained structural issues that exacerbate health inequity...

Mithani et al. argue that bioethics should more actively resist racial injustice and expand the range of voices heard beyond those historically considered. We largely agree with the authors’...

Like many fields, bioethics has been constrained to thinking to race in terms of colorblindness, the idea that ideal deliberation would ignore race and hence prevent bias. There are practical and ethically significant problems with colorblind approaches to ethical deliberation, and important reasons why race is ethically relevant. Future discourse needs to understand how and why race is relevant in bioethics.

In “Racism and Bioethics: the myth of color blindness” Braddock convincingly argues that a “color blind” approach to triage and resource allocation in the setting of the COVID-19 pandemic pe...

“Hypertension in Blacks is a salt disease,” Dr. Anderson 1 explained. “Too much salt overloads their renin-angiotensin system and their kidneys can’t handle it. It’s just the way their bodies work....

What does it mean to wear the white coat? I began to grapple with this as an internal medicine intern. I trained at Duke, where the dress code was more formal than at my medical school. Other than...

Events in the US in 2020 have laid bare the reality that racism and its effects continue to take a heavy toll on the lives of Black Americans. The three articles in this issue of AJOB each provide...

Research into epistemic injustice, the practice of discrediting people as knowers based on their social identity, has gained broad popularity in ethics. Racism in medicine often mani...

This month the American Journal of Bioethics examines the intersectionality of medicine, ethics, and race. In “Race, Power, and COVID-19: A Call for Advocacy Within Bioethics,” Mithani and colleagu...

In their target article, Zamina Mithani, Jane Cooper, and J. Wesley Boyd make a compelling case for the importance of “counter storytelling” in bioethics. They obse...

In a plenary presentation on structural racism at the 2019 American Society of Bioethics and Humanities Annual Meeting, invited speaker Mary T. Bassett asserted that there is no solidarity without...

The three target articles constitute a powerful and persuasive call for actively anti-racist bioethics and biomedicine. All three articles reject race as a biological category. Nevertheless, they s...

As the twin pandemics of COVID-19 and state violence against Black Americans dominated our national landscape in the spring of 2020, many in medicine, nursing, and public health made renewed calls...

Audre Lorde wrote in her essay The Transformation of Silence into Language to Action, “I have come to believe over and over again that what is most important to me must be spoken, made verbal and s...

The three important target articles make a strong case for regarding racism as a public health crisis. Each calls for advocacy by the bi...

We applaud and support the call by Mithani et al. for “a proactive form of bioethics that actively resists and denounces i...

The robustness of a health system can often be assessed by its response to unpredictable circumstances that demand resourcefulness and resilience. The ongoing COVID-19 pandemic has similarly challe...

Counter storytelling, used in critical race theory and narrative ethics, is a tool used to contradict and expose the oppression in a dominant narrative, by focusing attention on the stories of the...

There are some long-standing social issues that imperil Black Americans’ relationship with health and healthcare. These issues include racial disparities in health outcomes, provider bi...

Racial inequities in medicine are the consequence of intersecting, multidimensional factors. As detailed in the articles by Braddock, Mithani, Cooper, and Boyd, and Yearby, the...

Health care in the United States, being a microcosm of the broader society in which it developed, possesses a sordid legacy concerning racial prejudices, biases, and the perpetuation of health and...

Like more than two hundred thousand other Americans, George Floyd howled horribly for air before his death. But his breathlessness was not born from a virus. He was murdered with the burden of anti...

COVID-19 has disproportionately affected ethnic minorities and migrants, not only through an increased risk of infection and death, but also through experiences of harassment, mar...

“Ignorance,” Jim Hudson, the art dealer, declares shortly before the climactic scene in the 2017 film, Get Out. “They mean well, but they have no idea what real people will go through”...

What consciousness exactly is remains an unsettled issue among both philosophers and biologists. Three aspects of consciousness are generally recognized: awareness consciousness (through connection...

Human neural organoid research is advancing rapidly. As Greely notes in the target article, this progress presents an “onrushing ethical dilemma.” We can’t rule out the possibility that suff...

Brian Earp’s and Julian Savulescu’s provocatively titled “Love Drugs: The Chemical Future of Relationships” is a philosophically rigorous, scientifically informed, and yet wholly accessible study o...

Given the broad coverage of “Human Brain Surrogates Research: The Onrushing Ethical Dilemma,” this commentary focuses on the section “human/nonhuman brain chimeras,” and specifically, the questions...

In the years just prior to the COVID-19 pandemic, American clinicians and health care systems were focused on another life-threatening disease: opioid use disorder and the epidemic of deaths...

Just as the COVID-19 pandemic has laid bare the limitations of medical codes of ethics (London 2021), it has also laid bare the limitations of scientific codes of ethics, particularly with regard to expert communication. This commentary will argue that scientific experts may face a fundamental dilemma between prioritizing actionability and prioritizing scientific transparency in their communications, and moreover, that this dilemma has an ethical dimension that should be anticipated in ethical guidelines for scientists.

The COVID-19 pandemic has impacted almost every aspect of daily life, from whether and where people work, to their ability to easily obtain necessities like flour and toilet paper. Healthcare has b...

Sickle cell disease describes an inherited group of blood disorders that affect the lives of more than 4 million people around the globe. More than 43 million additional people are believed t...

The COVID-19 pandemic has led to the largest sudden global change to community life in living memory. Since being declared a pandemic in early 2020, there has been a growing body of evidence that h...

Human brain research is moving into a dilemma. The best way to understand how the human brain works is to study living human brains in living human beings, but ethical and legal standards make it d...

Clinicians such as Sir William Osler reinvented Hippocrates and built the image of a noble, lone, professional man replete with black bag, minister...

Throughout the 20th century, many doctors did not view pain management as an important aspect of their practice. Because pain cannot be objectively measured by the doctor, many doctors found it dif...

Greely’s target article outlines six categories of ethical issues associated with human brain surrogate research. Some of these issues are familiar from other research contexts; others, less...

Declan and Karesha’s case reflects one of the most challenging narratives resulting from the COVID-19 pandemic: the experience of isolation, frustration, and disconnection for patients and their fa...

As given, the case presents at least two questions for the ethics consultant to explore: to what extent should Declan’s parent, Karesha, be involved in his health care decisions, and why is...

“Facts don’t come with their own meaning attached.” Tzvetan Todorov Alex John London is frustrated by the commonly encountered situation of doctors thinking that they know what is bes...

Statements of the core ethical and professional responsibilities of medical professionals are incomplete in ways that threaten fundamental goals of medicine. First, in the absence of explicit guida...

In his Target Article, Greely examines brain surrogates and the ethical dilemma they pose: …we may make our models so good that they themselves deserve some of the kinds of ethical and legal respec...

The global landscape in which we wrote this essay has fundamentally changed. Given how these changes have altered the rhythm of life, particularly the added responsibilities that many of you have a...

Few would disagree with the notion that it would be a wonderful thing if we could more quickly learn how to treat, or better yet cure, diseases afflicting millions of people. Alex John London argue...

Greely argues that surrogates for living human brains in vivo might be of tremendous benefit to understanding human brain function—and eventually to curing devastating brain diseases—without...

Although neurological disease and mental illness can cause terrible human suffering, strategies for researching their causes and cures are not obvious. Invasive brain research on actual human being...

In “Self-Defeating Codes of Medical Ethics and How to Fix Them: Failures in COVID-19 Response and Beyond”, Alex London soundly argues that statements of the core ethical and professio...

In his timely and insightful article London criticizes professional codes of ethics as they encourage diversity in treatment practice without sufficiently promoting the kind of research whic...

Hank Greely’s target article, “Human Brain Surrogates Research: The Onrushing Ethical Dilemma” reviews the manifold scientific and ethical questions surrounding models of human brains used i...

Since Spring of 2020, health care facilities across the globe have accommodated to the stark reality of altered standards of care during the COVID-19 pandemic by drastically limiting family visitat...

As a result of the world-wide COVID-19 epidemic, an internal tension in the goals of medicine has come to the forefront of public debate. Medical professionals are continuously faced with a tug of...

As a 21 year-old patient, Declan does maintain legal decision-making authority and is empowered to consent to his own care in an autonomous way. Declan still lives with his mother and has historica...

My paper builds on the conceptual tools from three interrelated philosophical debates that—as I believe—may help structure important if chaotic discussions about surrogates for living human brains and resolve some practical issues related to regulatory matters. In particular, I refer to the discussions about the “moral precautionary principle” in research ethics (Koplin and Wilkinson 2019); about normative uncertainty in ethics (MacAskill, Bykvist, and Ord 2020), and about the inductive risk problem for animal welfare scientists (Birch 2018). I elucidate upon the (...) possible meanings of the phrase “a too good human brain surrogate” used by Henry T. Greely (2021), and I demonstrate that the evaluation of the practical and regulatory implications of the “goodness” of such surrogates created for research purposes should be sensitive to the possible consequences of two types of errors: the under-attribution and over-attribution of moral status to such beings. Many authors writing about this topic (including Greely 2021, but see also, e.g., Koplin and Savulescu 2019) concentrate only on the first type of error, neglecting the negative consequences of the second type, i.e., over-attribution. (shrink)