Hastings Center Report

ISSN: 0093-0334

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  1.  1
    Ethical Challenges of Advances in Vaccine Delivery Technologies.Arthur L. Caplan, Kyle Ferguson & Anne Williamson - 2024 - Hastings Center Report 54 (1):13-15.
    Strategies to address misinformation and hesitancy about vaccines, including the fear of needles, and to overcome obstacles to access, such as the refrigeration that some vaccines demand, strongly suggest the need to develop new vaccine delivery technologies. But, given widespread distrust surrounding vaccination, these new technologies must be introduced to the public with the utmost transparency, care, and community involvement. Two emerging technologies, one a skin‐patch vaccine and the other a companion dye and detector, provide excellent examples of greatly improved (...)
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  2.  1
    Hidden Ethical Challenges in Health Data Infrastructure.Nicole Contaxis - 2024 - Hastings Center Report 54 (1):15-19.
    Data infrastructure includes the bureaucratic, technical, and social mechanisms that assist in actions like data management, analysis, storage, and sharing. While issues like data sharing have been addressed in depth in bioethical literature, data infrastructure presents its own ethical considerations, apart from the actions (such as data sharing and data analysis) that it enables. This essay outlines some of these considerations—namely, the ethics of efficiency, the visibility of infrastructure, the power of standards, and the impact of new technologies—in order to (...)
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  3.  1
    Neuroscience and Society: Supporting and Unsettling Public Engagement.Gregory E. Kaebnick - 2024 - Hastings Center Report 54 (1):20-23.
    Advancing neuroscience is one of many topics that pose a challenge often called “the alignment problem”—the challenge, that is, of assuring that science policy is responsive to and in some sense squares with the public's values. This issue of the Hastings Center Report launches a series of scholarly essays and articles on the ethical and social issues raised by this vast body of medical research and bench science. The series, which will run under the banner “Neuroscience and Society,” is supported (...)
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  4.  1
    Identity Theft, Deep Brain Stimulation, and the Primacy of Post‐trial Obligations.Joseph J. Fins, Amanda R. Merner, Megan S. Wright & Gabriel Lázaro-Muñoz - 2024 - Hastings Center Report 54 (1):34-41.
    Patient narratives from two investigational deep brain stimulation trials for traumatic brain injury and obsessive‐compulsive disorder reveal that injury and illness rob individuals of personal identity and that neuromodulation can restore it. The early success of these interventions makes a compelling case for continued post‐trial access to these technologies. Given the centrality of personal identity to respect for persons, a failure to provide continued access can be understood to represent a metaphorical identity theft. Such a loss recapitulates the pain of (...)
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  5.  2
    Brain Pioneers and Moral Entanglement: An Argument for Post‐trial Responsibilities in Neural‐Device Trials.Sara Goering, Andrew I. Brown & Eran Klein - 2024 - Hastings Center Report 54 (1):24-33.
    We argue that in implanted neurotechnology research, participants and researchers experience what Henry Richardson has called “moral entanglement.” Participants partially entrust researchers with access to their brains and thus to information that would otherwise be private, leading to created intimacies and special obligations of beneficence for researchers and research funding agencies. One of these obligations, we argue, is about continued access to beneficial technology once a trial ends. We make the case for moral entanglement in this context through exploration of (...)
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  6.  5
    Digital Humans to Combat Loneliness and Social Isolation: Ethics Concerns and Policy Recommendations.Nancy S. Jecker, Robert Sparrow, Zohar Lederman & Anita Ho - 2024 - Hastings Center Report 54 (1):7-12.
    Social isolation and loneliness are growing concerns around the globe that put people at increased risk of disease and early death. One much‐touted approach to addressing them is deploying artificially intelligent agents to serve as companions for socially isolated and lonely people. Focusing on digital humans, we consider evidence and ethical arguments for and against this approach. We set forth and defend public health policies that respond to concerns about replacing humans, establishing inferior relationships, algorithmic bias, distributive justice, and data (...)
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  7.  1
    Challenging Disability Discrimination in the Clinical Use of PDMP Algorithms.Elizabeth Pendo & Jennifer Oliva - 2024 - Hastings Center Report 54 (1):3-7.
    State prescription drug monitoring programs (PDMPs) use proprietary, predictive software platforms that deploy algorithms to determine whether a patient is at risk for drug misuse, drug diversion, doctor shopping, or substance use disorder (SUD). Clinical overreliance on PDMP algorithm‐generated information and risk scores motivates clinicians to refuse to treat—or to inappropriately treat—vulnerable people based on actual, perceived, or past SUDs, chronic pain conditions, or other disabilities. This essay provides a framework for challenging PDMP algorithmic discrimination as disability discrimination under federal (...)
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  8.  3
    Care or Complicity? Medical Personnel in Prisons.Rebecca L. Walker - 2024 - Hastings Center Report 54 (1):2-2.
    Imprisonment may sometimes be a justified form of punishment. Yet the U.S. carceral system suffers from appalling problems of justice—in who is put into prisons, in how imprisoned people are treated, and in downstream personal and community health impacts. Medical personnel working in prisons and jails take on risky work for highly vulnerable and underserved patients. They are to be lauded for their professional commitments. Yet at the same time, prison care undercuts the ability of medical personnel to uphold their (...)
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  9.  5
    Opening the Door: Rethinking “Difficult Conversations” about Living and Dying with Dementia.Mara Buchbinder & Nancy Berlinger - 2024 - Hastings Center Report 54 (S1):22-28.
    This essay looks closely at metaphors and other figures of speech that often feature in how Americans talk about dementia, becoming part of cultural narratives: shared stories that convey ideas and values, and also worries and fears. It uses approaches from literary studies to analyze how cultural narratives about dementia may surface in conversations with family members or health care professionals. This essay also draws on research on a notable social effect of legalizing medical aid in dying: patients may find (...)
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  10.  4
    Too Soon or Too Late: Rethinking the Significance of Six Months When Dementia Is a Primary Diagnosis.Cindy L. Cain & Timothy E. Quill - 2024 - Hastings Center Report 54 (S1):29-32.
    Cultural narratives shape how we think about the world, including how we decide when the end of life begins. Hospice care has become an integral part of the end‐of‐life care in the United States, but as it has grown, its policies and practices have also imposed cultural narratives, like those associated with the “six‐month rule” that the majority of the end of life takes place in the final six months of life. This idea is embedded in policies for a range (...)
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  11.  3
    What Makes a Better Life for People Facing Dementia? Toward Dementia‐Friendly Health and Social Policy, Medical Care, and Community Support in the United States.Barak Gaster & Emily A. Largent - 2024 - Hastings Center Report 54 (S1):40-47.
    Taking steps to build a more dementia‐friendly society is essential for addressing the needs of people experiencing dementia. Initiatives that improve the quality of life for those living with dementia are needed to lessen controllable factors that can negatively influence how people envision a future trajectory of dementia for themselves. Programs that provide better funding and better coordination for care support would lessen caregiver burden and make it more possible to imagine more people being able to live what they might (...)
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  12.  6
    Guiding the Future: Rethinking the Role of Advance Directives in the Care of People with Dementia.Barak Gaster & Thaddeus Mason Pope - 2024 - Hastings Center Report 54 (S1):33-39.
    When people lose capacity to make a medical decision, the standard is to assess what their preferences would have been and try to honor their wishes. Dementia raises a special case in such situations, given its long, progressive trajectory during which others must make substituted judgments. The question of how to help surrogates make better‐informed decisions has led to the development of dementia‐specific advance directives, in which people are given tools to help them communicate what their preferences are while they (...)
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  13.  4
    When People Facing Dementia Choose to Hasten Death: The Landscape of Current Ethical, Legal, Medical, and Social Considerations in the United States.Emily A. Largent, Jane Lowers, Thaddeus Mason Pope, Timothy E. Quill & Matthew K. Wynia - 2024 - Hastings Center Report 54 (S1):11-21.
    Some individuals facing dementia contemplate hastening their own death: weighing the possibility of living longer with dementia against the alternative of dying sooner but avoiding the later stages of cognitive and functional impairment. This weighing resonates with an ethical and legal consensus in the United States that individuals can voluntarily choose to forgo life‐sustaining interventions and also that medical professionals can support these choices even when they will result in an earlier death. For these reasons, whether and how a terminally (...)
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