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  1. Enrolling in Clinical Research While Incarcerated: What Influences Participants’ Decisions?Paul P. Christopher, Lorena G. Garcia‐Sampson, Michael Stein, Jennifer Johnson, Josiah Rich & Charles Lidz - 2017 - Hastings Center Report 47 (2):21-29.
    As a 2006 Institute of Medicine report highlights, surprisingly little empirical attention has been paid to how prisoners arrive at decisions to participate in modern research. With our study, we aimed to fill this gap by identifying a more comprehensive range of factors as reported by prisoners themselves during semistructured interviews. Our participants described a diverse range of motives, both favoring and opposing their eventual decision to join. Many are well-recognized considerations among nonincarcerated clinical research participants, including a desire for (...)
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  2. Bioethics and “Rightness”.Arthur W. Frank - 2017 - Hastings Center Report 47 (2):page inside back cover-page insi.
    If bioethics seeks to affect what people do and don't do as they respond to the practical issues that confront them, then it is useful to take seriously people's sense of rightness. Rightness emerges from the fabric of a life—including the economy of its geography, the events of its times, its popular culture—to be what the sociologist Pierre Bourdieu calls a predisposition. It is the product of a way of life and presupposes continuing to live that way. Rightness is local (...)
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  3.  2
    Facts, Values, and Journalism.Susan Gilbert - 2017 - Hastings Center Report 47 (2):page inside front cover-page ins.
    At a time of fake news, hacks, leaks, and unverified reports, many people are unsure whom to believe. How can we communicate in ways that make individuals question their assumptions and learn? My colleagues at The Hastings Center and many journalists and scientists are grappling with this question and have, independently, reached the same first step: recognize that facts can't be fully understood without probing their connection to values. “Explaining the basics is important, of course, but we also need to (...)
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  4. Justifying Clinical Nudges.Moti Gorin, Steven Joffe, Neal Dickert & Scott Halpern - 2017 - Hastings Center Report 47 (2):32-38.
    The shift away from paternalistic decision-making and toward patient-centered, shared decision-making has stemmed from the recognition that in order to practice medicine ethically, health care professionals must take seriously the values and preferences of their patients. At the same time, there is growing recognition that minor and seemingly irrelevant features of how choices are presented can substantially influence the decisions people make. Behavioral economists have identified striking ways in which trivial differences in the presentation of options can powerfully and predictably (...)
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  5. Best Evidence Aside: Why Trump's Executive Order Makes America Less Healthy.Lawrence O. Gostin - 2017 - Hastings Center Report 47 (2):5-6.
    What are the health impacts of President Trump's January 27, 2017, executive order suspending the resettlement of refugees and temporarily banning entry of nationals from Iraq, Syria, Iran, Sudan, Libya, Somalia, and Yemen? Even if the President's constitutional arguments are credible, the order is deeply troubling under international law and humanitarian values. Under the 1967 Refugee Protocol, the United States has assumed a legal obligation to examine the claims of asylum seekers who reach U.S. territory without discrimination based on race, (...)
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  6. Space for the Prisoner's Point of View.Laura Haupt - 2017 - Hastings Center Report 47 (2):2-2.
    The lead article in this issue discusses a potentially free metaphorical space—that of decision-making—within the confines, tangible and intangible, of life in jail or prison. By interviewing prisoner-participants from six clinical studies, Paul Christopher and colleagues sought to find out how these men and women would answer open-ended questions about their decision to enroll in the research. What the interviewers heard was that none saw themselves as having been inappropriately pressured to do so. In fact, a significant percentage of the (...)
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  7. Rethinking Reprogenetics.Michael Hauskeller - 2017 - Hastings Center Report 47 (2):50-51.
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  8.  1
    Reprioritizing Research Activity for the Post‐Antibiotic Era: Ethical, Legal, and Social Considerations.Spencer Phillips Hey & Aaron S. Kesselheim - 2017 - Hastings Center Report 47 (2):16-20.
    Many hold that the so-called golden era of antibiotic discovery has passed, leaving only a limited clinical pipeline for new antibiotics. A logical conclusion of such arguments is that we need to reform the current system of antibiotic drug research—including clinical trials and regulatory requirements—to spur activity in discovery and development. The United States Congress in the past few years has debated a number of bills to address this crisis, including the 2012 Generating Antibiotic Incentives Now Act and the 2016 (...)
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  9.  1
    Authenticity, Best Interest, and Clinical Nudging.Søren Holm - 2017 - Hastings Center Report 47 (2):38-40.
    In this issue of the Hastings Center Report, Moti Gorin, Steven Joffe, Neal Dickert, and Scott Halpern offer a comprehensive defense of the use of nudging techniques in the clinical context, with the aim of promoting the best interests of patients. Their argument is built on three important claims: Nudging is ubiquitous and inescapable in clinical choice situations, and there is no neutral way of informing patients about their treatment choices; many patients do not have authentic preferences concerning their treatment (...)
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  10. Implementing California's Law on Assisted Dying.Ruchika Mishra - 2017 - Hastings Center Report 47 (2):7-8.
    On October 5, 2015, Governor Jerry Brown approved bill ABX2 15, the End of Life Option Act, making California the fifth state in the country to allow physician-assisted dying. The law was modeled after Oregon's 1997 Death with Dignity Act. When the legislative special session ended on March 10, 2016, California health care providers had only ninety days to respond to the state mandate before the law would take effect, on June 9, 2016. Experience with the law so far suggests (...)
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  11. Toward an Ethically Sensitive Implementation of Noninvasive Prenatal Screening in the Global Context.Jessica Mozersky, Vardit Ravitsky, Rayna Rapp, Marsha Michie, Subhashini Chandrasekharan & Megan Allyse - 2017 - Hastings Center Report 47 (2):41-49.
    Noninvasive prenatal screening using cell-free DNA, which analyzes placental DNA circulating in maternal blood to provide information about fetal chromosomal disorders early in pregnancy and without risk to the fetus, has been hailed as a potential “paradigm shift” in prenatal genetic screening. Commercial provision of cell-free DNA screening has contributed to a rapid expansion of the tests included in the screening panels. The tests can include screening for sex chromosome anomalies, rare subchromosomal microdeletions and aneuploidies, and most recently, the entire (...)
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  12. Coercion and Access to Health Care.Keramet Reiter - 2017 - Hastings Center Report 47 (2):30-31.
    In this issue of the Hastings Center Report, Paul Christopher and colleagues describe a study of why prisoners choose to enroll in clinical research. The article represents an important methodological and policy contribution to the literature on prisoner participation in research and medical experimentation. Given the methodological and ethical debates to which this research seeks to make an empirical contribution, the careful manner in which the study was conducted and the transparency with which the authors describe the research is especially (...)
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  13. Managing Opioid Withdrawal for Hospital Patients in Custody.R. Shi Connie, S. Kandola Manjinder, Tobey Matthew & Singer Elizabeth - 2017 - Hastings Center Report 47 (2):9-10.
    Dr. Brown, a hospitalist, admits Mark, a patient transferred from a local jail for management of cellulitis. The patient, who was taken into custody two days prior to hospital admission, has a history of intravenous heroin use. Mark explains that he had been prescribed buprenorphine-naloxone maintenance therapy for opioid use disorder for several years prior to being arrested and had not used other opioids during that time. As a policy, the jail where Mark is detained does not prescribe opioid agonists, (...)
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  14. Bioethics and Populism: How Should Our Field Respond?Mildred Z. Solomon & Bruce Jennings - 2017 - Hastings Center Report 47 (2):11-16.
    Across the world, an authoritarian and exclusionary form of populism is gaining political traction. Historically, some populist movements have been democratic and based on a sense of inclusive justice and the common good. But the populism on the rise at present speaks and acts otherwise. It is challenging constitutional democracies. The polarization seen in authoritarian populism goes beyond the familiar left-right political spectrum and generates disturbing forms of extremism, including the so-called alternative right in the United States and similar ethnic (...)
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  15. The Clue.Tyler Tate - 2017 - Hastings Center Report 47 (2):3-4.
    As I stood outside of Carlos's room, I felt caught on the horns of a dilemma. It seemed impossible to truly “be there” for Carlos without sacrificing my other intern duties. This tension pervaded much of my residency training, as I often found myself spending more time completing chart notes, answering pages, and giving sign out than I did at the bedside with my patients. I knew I had a duty to “do my job”—I could not let my team down. (...)
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  16. Managing Conflicts Between Physicians and Surrogates.Carol Bayley - 2017 - Hastings Center Report 47 (1):24-26.
    Two articles in this issue of the Hastings Center Report explore two sides of the same problematic coin. In “The Limits of Surrogates’ Moral Authority and Physician Professionalism,” Jeffrey Berger discusses the moral problem of a surrogate refusing a treatment, palliative sedation, on behalf of a patient whose suffering is refractory to intensive palliative efforts provided by a multidisciplinary team. In “After the DNR: Surrogates Who Persist in Requesting Cardiopulmonary Resuscitation,” Ellen Robinson and her colleagues analyze data from a study (...)
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  17.  1
    The Limits of Surrogates’ Moral Authority and Physician Professionalism: Can the Paradigm of Palliative Sedation Be Instructive?Jeffrey T. Berger - 2017 - Hastings Center Report 47 (1):20-23.
    With narrow exception, physicians’ treatment of incapacitated patients requires the consent of health surrogates. Although the decision-making authority of surrogates is appropriately broad, their moral authority is not without limits. Discerning these bounds is particularly germane to ethically complex treatments and has important implications for the welfare of patients, for the professional integrity of clinicians, and, in fact, for the welfare of surrogates. Palliative sedation is one such complex treatment; as such, it provides a valuable model for analyzing the scope (...)
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  18.  2
    The ACA From Behind the “Veil of Ignorance”.Susan Dentzer - 2017 - Hastings Center Report 47 (1):inside back cover-inside back co.
    John Rawls posited that we could determine the nature of justice if we imagined ourselves observing conditions in society from behind a hypothetical “veil of ignorance.” Not knowing how or where we would end up—rich, poor, empowered, disabled—we would choose governing principles that did not leave one disadvantaged because of his or her circumstances. Rawls's concepts are implicitly embedded in the Affordable Care Act, which guarantees that vastly more Americans can obtain health insurance. The law effectively closed down the de (...)
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  19. Care Under the Influence.Joseph J. Fins & Samantha F. Knowlton - 2017 - Hastings Center Report 47 (1):8-9.
    A forty-year-old man is brought to the emergency room by his wife at five in the morning, two hours after he fell down the stairs at home, hitting his head and injuring his arm. He tells the ER physician that he got up to get a drink of water and tripped in the dark. His speech is slurred, and he smells strongly of alcohol. Lab results reveal elevated liver enzymes, and his blood alcohol level is 0.1. His medical history is (...)
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  20.  1
    Permanent Patients: Hospital Discharge Planning Meets Housing Insecurity.Jennifer L. Herbst - 2017 - Hastings Center Report 47 (1):6-7.
    Not all hospital inpatients need the level of care uniquely available in the acute-care setting. In the United States, these longer-term, nonacute inpatients tend to be some combination of chronically ill, poor, homeless, undocumented, uninsured, and disabled—all groups who have struggled for health equity, political recognition, and voice. Even so, these “permanent patients” continue to receive care in one of the most expensive settings. This phenomenon is the result of federal legislation that creates an affirmative duty to care for all (...)
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  21. Decisions and Authority.Gregory E. Kaebnick - 2017 - Hastings Center Report 47 (1):2-2.
    This issue of the Hastings Center Report features three articles exploring aspects of decision-making for others. In the first two, the focus is on the limits of surrogate decision-makers’ authority when the surrogates’ judgments about a patient's treatment conflict with the physicians’. If a physician decides that a patient will not benefit from CPR, for example, but the patient's surrogate insists on it, is the physician obliged to proceed with the procedure? Or can the physician, pointing to a duty to (...)
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  22. Childbearing Choices: What Helps, What Doesn't, and What You Thought You Knew.Mark R. Mercurio - 2017 - Hastings Center Report 47 (1):42-43.
    Childbearing is an increasingly complicated matter, which has evolved significantly over the past several decades. Treatment options for infertility have expanded. Prenatal testing and treatment have led to an evolution in obstetrical decision-making, wherein the risks and benefits to the fetus and future child are better understood and more strongly considered in medical management of the pregnant woman. Obstetrics appears to be increasingly interventional; one in three babies in the United States is now born by cesarean section. Neonatal intensive care (...)
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  23.  1
    A Good Death.Tia Powell & Adira Hulkower - 2017 - Hastings Center Report 47 (1):28-29.
    A good death is hard to find. Family members tell us that loved ones die in the wrong place—the hospital—and do not receive high-quality care at the end of life. This issue of the Hastings Center Report offers two articles from authors who strive to provide good end-of-life care and to prevent needless suffering. We agree with their goals, but we have substantial reservations about the approaches they recommend. Respect for the decisions of patients and their surrogates is a relatively (...)
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  24.  1
    After the DNR: Surrogates Who Persist in Requesting Cardiopulmonary Resuscitation.Ellen M. Robinson, Wendy Cadge, Angelika A. Zollfrank, M. Cornelia Cremens & Andrew M. Courtwright - 2017 - Hastings Center Report 47 (1):10-19.
    Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...)
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  25.  1
    Employer Wellness Programs Challenged in Court.Mark A. Rothstein - 2017 - Hastings Center Report 47 (1):4-5.
    Many employers faced with rising health care costs have adopted “voluntary” wellness programs that urge employees to engage in various health-promotion activities, such as smoking cessation and weight reduction. In the proper setting, measures to promote a more healthful lifestyle are difficult to question, but there is little compelling evidence that workplace wellness programs have significant, sustained health benefits or substantially reduce health care costs other than through cost-shifting to unhealthy employees. Congressional support for workplace wellness programs has persisted on (...)
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  26. Conflating Capacity & Authority: Why We're Asking the Wrong Question in the Adolescent Decision‐Making Debate.Erica K. Salter - 2017 - Hastings Center Report 47 (1):32-41.
    Whether adolescents should be allowed to make their own medical decisions has been a topic of discussion in bioethics for at least two decades now. Are adolescents sufficiently capacitated to make their own medical decisions? Is the mature-minor doctrine, an uncommon legal exception to the rule of parental decision-making authority, something we should expand or eliminate? Bioethicists have dealt with the curious liminality of adolescents—their being neither children nor adults—in a variety of ways. However, recently there has been a trend (...)
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  27.  1
    Show Code.Shalev Daniel - 2017 - Hastings Center Report 47 (1):3-3.
    “Let's get one thing straight: there is no such thing as a show code,” my attending asserted, pausing for effect. “You either try to resuscitate, or you don't. None of this halfway junk.” He spoke so loudly that the two off-service consultants huddled at computers at the end of the unit looked up… We did four rounds of compressions and pushed epinephrine twice. It was not a long code. We did good, strong compressions and coded this man in earnest until (...)
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  28.  1
    Bioethics in the Law.Zachary E. Shapiro - 2017 - Hastings Center Report 47 (1):inside front cover-inside front.
    The role of law in bioethics is clear. Laws are enforcement tools: they govern which conditions qualify an individual for disability benefits, or what oversight is necessary for clinical trial protocols, or how patent applications for medical devices should be regulated. I initially studied the law in order to enhance my work in bioethics, but in examining how the law works, I have become convinced that the converse opportunity also exists: there are many areas of law that would benefit from (...)
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  29. On Patient Well‐Being and Professional Authority.Mildred Z. Solomon - 2017 - Hastings Center Report 47 (1):26-27.
    Two papers in this issue address the limits of surrogates’ authority when making life-and-death decisions for dying family members or friends. Using palliative sedation as an example, Jeffrey Berger offers a conceptual argument for bounding surrogate authority. Since freedom from pain is an essential interest, when imminently dying, cognitively incapacitated patients are in duress and their symptoms are not manageable in any other way, clinicians should be free to offer palliative sedation without surrogate consent, although assent should be sought and (...)
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  30. The Theory and Practice of Surrogate Decision‐Making.David Wendler - 2017 - Hastings Center Report 47 (1):29-31.
    When a patient lacks decision-making capacity and has not left a clear advance directive, there is now widespread agreement that patient-designated and next-of-kin surrogates should implement substituted judgment within a process of shared decision-making. Specifically, after discussing the “best scientific evidence available, as well as the patient's values, goals, and preferences” with the patient's clinicians, the patient-designated or next-of-kin surrogate should attempt to determine what decision the patient would have made in the circumstances. To the extent that this approach works, (...)
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