This essay summarizes key insights across the essays in the Hastings Center Report's special report “Time to Rebuild: Essays on Trust in Health Care and Science.” These insights concern trust and trustworthiness as distinct concepts, competence as a necessary but not sufficient input to trust, trust as a reciprocal good, trust as an interpersonal as well as structural phenomena, the ethical impermissibility of seeking to win trust without being trustworthy, building and borrowing trust as distinct strategies, and challenges to trustworthiness (...) posed by the contingent nature of science. Together, these insights stand to advance an area of research that we believe has been historically stymied by conceptual confusion and a long‐standing insistence on treating trust as a purely instrumental good. (shrink)

The release of genetically engineered organisms into the shared environment raises scientific, ethical, and societal issues. Using some form of democratic deliberation to provide the public with a voice on the policies that govern these technologies is important, but there has not been enough attention to how we should connect public deliberation to the existing regulatory process. Drawing on lessons from previous public deliberative efforts by U.S. federal agencies, we identify several practical issues that will need to be addressed if (...) relevant federal agencies are to undertake public deliberative activities to inform decision‐making about gene editing in the wild. We argue that, while agencies may have institutional capacity to undertake public deliberative activities, there may not be sufficient political support for them to do so. Advocates of public deliberation need to make a stronger case to Congress about why federal agencies should be encouraged and supported to conduct public deliberations. (shrink)

Both articles in the November‐December 2021 issue of the Hastings Center Report reflect bioethics’ growing interest in questions of justice, or more generally, questions of how collective interests constrain individual interests. Hugh Desmond argues that human enhancement should be reconsidered in light of developments in the field of human evolution. Contemporary understandings in this area lead, he argues, to a new way of thinking about the ethics of enhancement—an approach that replaces personal autonomy with group benefit as the primary criterion (...) for deciding what enhancements are acceptable. In the second article, Johannes Kniess considers the many attempts within bioethics to draw on John Rawls's work to discuss health care access and social determinants of health, and he comes across as moderately optimistic that Rawls's theory of justice has ongoing relevance. (shrink)

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 (...) by the Dana Foundation and seeks to promote deliberative public engagement, broadly understood, about neuroscience. As a social goal, deliberative public engagement is both ubiquitous and elusive—called for everywhere yet difficult to undertake at a national level on a complex scientific topic. To be meaningful, deliberative public engagement must occur in many locations in a society and be carried forward by many actors. Scholarly writing might contribute in several ways. (shrink)

Generative artificial intelligence (AI) has the potential to transform many aspects of scholarly publishing. Authors, peer reviewers, and editors might use AI in a variety of ways, and those uses might augment their existing work or might instead be intended to replace it. We are editors of bioethics and humanities journals who have been contemplating the implications of this ongoing transformation. We believe that generative AI may pose a threat to the goals that animate our work but could also be (...) valuable for achieving those goals. In the interests of fostering a wider conversation about how generative AI may be used, we have developed a preliminary set of recommendations for its use in scholarly publishing. We hope that the recommendations and rationales set out here will help the scholarly community navigate toward a deeper understanding of the strengths, limits, and challenges of AI for responsible scholarly work. (shrink)

The lead article in this January‐February 2021 issue—the first of the Hastings Center Report's fiftieth year of publication—does not set out to change medicine. It tries instead to understand it. In “A Heart without Life: Artificial Organs and the Lived Body,” Mary Jean Walker draws on work in phenomenology and on empirical research with people who have received artificial heart devices to argue that such devices may have two very different effects on how a patient experiences the body and the (...) self. Several other pieces in this issue address the ongoing slew of patient care and health policy problems surrounding the Covid‐19 pandemic, and a special report titled Democracy in Crisis: Civic Learning and the Reconstruction of Common Purpose considers the requirements for public involvement in policy‐making about bioethical issues. (shrink)

This essay introduces a special report from The Hastings Center entitled Democracy in Crisis: Civic Learning and the Reconstruction of Common Purpose, which grew out of a project supported by the John S. and James L. Knight Foundation. This multiauthored report offers wide‐ranging assessments of increasing polarization and partisanship in American government and politics, and it proposes constructive responses to this in the provision of objective information, institutional reforms in government and the electoral system, and a reexamination of cultural and (...) political values needed if democracy is to function well in a pluralistic and diverse society. The essays in the special report explore the norms of civic learning and institutions, social movements, and communal innovations that can revitalize civic learning in practice. This introductory essay defines and explains the notion of civic learning, which is a lynchpin connecting many of the essays in the report. Civic learning pertains to the ways in which citizens learn about collective social problems and make decisions about them that reflect the duties and responsibilities of citizenship. Such learning can occur in many social settings in everyday life, and it can also be facilitated through participation in the processes of democratic governance on many levels. Civic learning is not doctrinaire and is compatible with a range of public goals and policies. It is an activity that increases what might be called the democratic capability of a people. (shrink)

Bioethicists have sometimes regarded the opioid epidemic as a problem with obvious answers and thus no need for the field's conceptual analysis. Yet, as three essays in the July‐August 2020 issue of the Hastings Center Report demonstrate, the opioid crisis contains a knot of distinctions and puzzles to be sorted out. Travis N. Rieder examines, for example, what is fundamentally driving the crisis—access to the drugs or large societal problems such as poverty and joblessness. The role of choice in addiction, (...) the effects of moral condemnation on approaches to addiction, and what treatment should look like are among the puzzles Hanna Pickard explores, while Daniel S. Goldberg focuses on the common and harmful conflation of the public health problems of substance misuse and pain. These philosophical and bioethical questions point in widely different directions, lying both inside and outside bioethics. They point toward systemic societal factors that determine health and well‐being yet have seemed outside bioethics' largely clinical boundaries. And they point toward a deeper look at the very idea of autonomy—an examination of a topic clearly within bioethics yet occurring at the fringes of its usual constructs. (shrink)

In some sense, argues Christopher Meyers in the lead article in this, the July‐August 2021, issue of the Hastings Center Report, to be a good ethicist is to be an activist. The question for the ethicist, and for Meyers, is about how hard and far to push: how much personal risk to shoulder, how much to tick off colleagues, how much institutional disruption to create, how much to look like an angry protester. Meyers argues for aiming at the middle, in (...) two senses. In a time of anger and activism about relentless, pervasive, overwhelming wrongs, the question of balance is increasingly front of mind. A set of commentaries we solicited both welcome Meyers's call for activism and push for more. (shrink)

Hastings Center Report, Volume 52, Issue 2, Page 2-2, March‐April 2022.

In a 2015 Hastings Center Report essay, Robert Truog and his coauthors argued that the clinical ethics portion of medical education should cast both a wider and a finer net than is sometimes realized. Many of the morally important moments in patient care are missed if we teach only general moral principles, they held; we also need to give attention to an indefinite stream of “microethical” decisions in everyday clinical practice. In the current issue, Truog plays out a similar theme (...) as he discusses the moral significance of touching a patient and asks how artificial intelligence and other emerging technologies may change this ancient part of the physician‐patient relationship. And one of the articles in this issue examines the significance of clinicians’ relationships with other clinicians. Donna Chen and colleagues propose, in effect, that “teamwork” has become part of the ethics of everyday clinical practice—a new addition to what Larry Churchill and David Schenck called the “healing skills.”. (shrink)

I was recently asked to report on editorial trends in the Hastings Center Report, past and future. What I reported is that HCR has been going in two seemingly contrasting directions. One has to do with moral decision‐making in clinical ethics—the core theme in bioethics for fifty years, but still developing. A second editorial trend is treatment of larger social and political issues that bear on health, such as public health interventions and access to health care. I could also have (...) noted a continuing stream of pieces on emerging technologies, from whole‐genome screening for newborns to artificial intelligence in clinical diagnoses to the so‐called de‐extinction of extinct animals and plants through various genetic and reproductive tricks. This January‐February 2019 issue of HCR reflects all these trends. (shrink)

Hastings Center Report, Volume 52, Issue 3, Page 2-2, May–June 2022.

Hastings Center Report, Volume 51, Issue 5, Page 2-2, September‐October 2021.

The lead article in the Hastings Center Report's November‐December 2020 issue reconsiders the rationale for requiring that patients have a prescription from a physician to obtain a drug. Madison Kilbride, Steve Joffe, and Holly Fernandez Lynch conclude that growing respect for patient autonomy should lead to a new default for drug access: drugs should be available over the counter unless there are special concerns about harms to third parties or about patients' ability to make decisions for themselves. This conclusion would (...) be a substantial reorientation of drug policy in the United States. Bioethics at a societal level is a theme in the second article, “The Social Risks of Science,” and throughout the issue. (shrink)

Two articles in the March‐April 2021 issue of the Hastings Center Report consider alterations to traditional informed consent. In “The Consent Continuum: A New Model of Consent, Assent, and Nondissent for Primary Care,” Marc Tunzi and colleagues argue that, in primary care settings, patient consent should be understood as taking a range of forms depending on the procedure, the patient, and the patient‐care context. Traditional informed consent is at the ceremonious end; for many things done in these settings, the authors (...) assert, assent or even nondissent is fine. In the lead article, health policy scholars Stephanie Morain and Emily Largent consider another continuum for informed consent, this one occurring with pragmatic research, at the intersection of clinical care with research. (shrink)

The lead article in this, the September‐October 2020, issue of the Hastings Center Report considers the use of metaphors in communications with clinicians and patients.

My academic training is in philosophy, and I tend to see the problems in bioethics as philosophical problems. And so they often are. What are moral values? What is the nature of rationality? These are certainly philosophical problems. But at the same time, they are not strictly philosophical problems, insofar as they are not the special purview of the field of philosophy. They require a broader treatment, and that broader treatment might even lead us to believe that the standard philosophical (...) treatment is unsatisfactory. In one way or another, several items in this issue of the Hastings Center Report raise questions about the standard philosophical answers to issues in bioethics. The challenge is... Read More. (shrink)