Introduction to the Special Issue on CRISPR.
PMID: 32063582 [PubMed - in process] (Source: Perspectives in Biology and Medicine)
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Daley GQ Tags: Perspect Biol Med Source Type: research

Commentary: Code Dread?
PMID: 32063583 [PubMed - in process] (Source: Perspectives in Biology and Medicine)
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Baer N Tags: Perspect Biol Med Source Type: research

How We Got to CRISPR: The Dilemma of Being Human.
This article considers the existential and eugenic risks of gene editing with CRISPR-Cas9. It brings forward epistemological and phenomenological questions concerning what CRISPR technology suggests about the limits of being human. By illuminating the paradoxical relationship between our "then self" and "now self," it considers the fragility of our individual and collective future-making endeavors. To do this, the article offers an overview of the existential dilemmas facing modern subjects, a history of eugenics and the ideology of health, a meditation on the limits of human knowledge, and an explicati...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Garland-Thomson R Tags: Perspect Biol Med Source Type: research

Focusing on Human Rights: a framework for CRISPR germline genome editing ethics and regulation.
Abstract The late 2018 announcement of the claimed births of CRISPR-edited babies has stimulated widespread condemnation and calls by some leading scientists for a moratorium on any further germline genome editing (GGE) for reproductive purposes. Concurrently, national and international bodies are calling for the development of robust guidelines and regulations that will identify permissible conditions under which such GGE efforts might eventually proceed. Crucially, these conditions go beyond rigorous safety standards to address some of the social and ethical concerns that arise with germline interventions. As th...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Doxzen K, Halpern J Tags: Perspect Biol Med Source Type: research

Who Goes First? Deaf People and CRISPR Germline Editing.
Abstract The development of CRISPR technology has catapulted the issue of germline editing to the forefront of a debate between the goals of medical advancement and promotion of human diversity. The US National Academy of Sciences and the National Academy of Medicine recommended in a joint report that germline editing should be tightly regulated and pursued only for "serious diseases." A follow-up statement from an international summit on human genome editing emphasized a more general point that "the risks [are] too great to permit clinical trials of germline editing at this time." Here we revi...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Padden C, Humphries J Tags: Perspect Biol Med Source Type: research

Billy Idol.
Abstract Ruthie Weiss was born with white hair, but her parents did not consider the possibility of there being more to the story until they noticed that she was not visually tracking when she was just a month old. Thus began a long and continuing story of the discovery of Ruthie's albinism, her significant visual impairment, but also her courage and determination to do anything and everything her peers do, if not more. But this story is really about how her parents grew to embrace the impact Ruthie (and importantly Ruthie's disability) had on their lives and the lives of everyone with whom Ruthie interacted. The ...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Weiss EJ Tags: Perspect Biol Med Source Type: research

CRISPR Cautions: Biosecurity Implications of Gene Editing.
Abstract CRISPR, a powerful gene-editing technology, is revolutionizing the life sciences and medical research. The technology has also become democratized. Costs to use CRISPR are low and decreasing, kits are available to make the use of CRISPR straightforward, and there is a rapidly growing scientific literature describing CRISPR methodologies and novel applications. However, like other powerful advances in the life sciences, CRISPR raises biosecurity concerns: it could be misused for harm, and it lowers technical barriers to biological weapons development. This essay describes the history and dissemination of C...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: West RM, Gronvall GK Tags: Perspect Biol Med Source Type: research

Who's Afraid of the Big Bad (Germline Editing) Wolf?
Abstract Germline genome editing has garnered dire predictions about its societal effects, but experience with other reproductive technologies should caution us about making extravagant claims. Amniocentesis was predicted to result in increased stigmatization of people born with Down syndrome, but in fact people with these conditions have been increasingly integrated into schools and workplaces. Artificial insemination by donor was predicted to result in women choosing to "optimize" their children, but in fact most women eschewed the offerings of the so-called "genius sperm bank," and when choo...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Charo RA Tags: Perspect Biol Med Source Type: research

Clinical Germline Genome Editing: < i > When Will < /i > Good < i > be < /i > Good Enough?
Clinical Germline Genome Editing: When Will Good be Good Enough? Perspect Biol Med. 2020;63(1):101-110 Authors: O'Neill HC Abstract Ensuring experimental outcomes are of the highest clinical caliber is crucial prior to the introduction of germline genome editing. However, if we are to police scientific progress using probability or the potential to go wrong, then we must account for the specious standards of human reproduction. With 15% of clinically recognized pregnancies estimated to end in spontaneous miscarriage within the first trimester, and 25% of all pregnancies ending in miscarriage, human re...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: O'Neill HC Tags: Perspect Biol Med Source Type: research

Playing it Safe? Precaution, Risk, and Responsibility in Human Genome Editing.
Abstract Human germline genetic modification has long been a controversial topic. Until recently it remained largely a hypothetical debate: whether one accepted or opposed the idea in principle, it was not only too risky but impractical to execute in reality. With the advent of genome editing technologies, however, heritable modifications to the human genome became a much more concrete possibility; nonetheless, the consensus has to date remained that human heritable genome editing is not yet safe enough for clinical application. The announcement of the birth of two genome-edited babies in late 2018, therefore, was...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Chan S Tags: Perspect Biol Med Source Type: research

Genome Editing and Human Reproduction: The Therapeutic Fallacy and the "Most Unusual Case".
Genome Editing and Human Reproduction: The Therapeutic Fallacy and the "Most Unusual Case". Perspect Biol Med. 2020;63(1):126-140 Authors: Mills PF Abstract In the current agon between those promoting and opposing the development of human reproductive applications of genome editing techniques, the bone of contention is often whether the prospective reproductive technologies answer an "unmet medical need." Proponents often point to highly unusual cases of inherited genetic conditions as exhibiting that need. This essay argues that we ought to admit that the opponents are correct: hu...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Mills PF Tags: Perspect Biol Med Source Type: research

Shaping the CRISPR Gene-Editing Debate: Questions About Enhancement and Germline Modification.
This article traces that lineage by identifying key distinctions and ethics questions in these preexisting lines of inquiry that are also employed in four recent policy and ethics statements on human gene editing. These distinctions and ethics questions can be helpful heuristics for organizing discussion, learning from existing analysis, and highlighting what is at stake with new gene-editing technologies. Yet scientists, policymakers, and others new to the ethics of emerging technologies should also be aware of both the limitations of these distinctions and past challenges in adequately addressing the ethics questions the...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Johnston J Tags: Perspect Biol Med Source Type: research

CRISPR's Twisted Tales: Clarifying Misconceptions about Heritable Genome Editing.
Abstract The raging controversy about whether heritable genome editing should be permitted is shaped and structured by the prevailing and countervailing narratives in circulation. In recent years, considerable shortcomings have come to characterize this discourse; it is now time to identify and correct a number of serious misunderstandings and distortions that have taken hold. This essay begins by briefly evaluating reactions to the November 2018 announcement that gene-edited babies had been born; it asserts that widespread agreement about the researcher's recklessness and dire ethical violations concealed deep fa...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Darnovsky M, Hasson K Tags: Perspect Biol Med Source Type: research

Imperatives of Governance: Human Genome Editing and the Problem of Progress.
Abstract The ability to make direct genetic changes to the DNA of future children poses profound challenges for governance. Over the last several years, efforts to establish frameworks of ethical deliberation and governance for human genome editing have focused largely on technical criteria for proceeding with research and rules and mechanisms for regulating it. Less attention has been given to the question of who decides, and on the basis of what authority. The power to decide is exercised not only in giving answers to ethical questions or suppling policy advice, but in designating what questions should (and shou...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Hurlbut JB Tags: Perspect Biol Med Source Type: research

The Existential Dimension to Aging.
Abstract In their recent book Aging Thoughtfully: Conversations about Retirement, Romance, Wrinkles, and Regret (2017), Martha C. Nussbaum and Saul Levmore consider their subject from two different personal and professional perspectives (philosophy and law, respectively) through the lenses of eight different topics: domination and control; forced retirement; friendship; the human body as it ages, primarily in aesthetic terms; backward-looking emotions; love in the later stages of life; wealth inequities among those who are older; and legacies. Yet they overlook other parts of the aging process that can be approach...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Morris T Tags: Perspect Biol Med Source Type: research

"Lost Your Superpower"? Graphic Medicine, Voicelessness, and Georgia Webber's < i > Dumb < /i > .
"Lost Your Superpower"? Graphic Medicine, Voicelessness, and Georgia Webber's Dumb. Perspect Biol Med. 2020;63(1):207-217 Authors: Venkatesan S, Dastidar DG Abstract Unlike deafness and disability, speech-related disorders-voluntary/involuntary voicelessness, mutism, and their imperatives-have largely remained undertheorized both as scholarship and praxis. Given the primacy and over-privileging of vision, a consideration of the nature of voice/voicelessness is critical and urgent. Framed in metaphysical, metaphorical, and existential terms, Georgia Webber's graphic memoir Dumb (2018), which ...
Source: Perspectives in Biology and Medicine - February 19, 2020 Category: Medical Ethics Authors: Venkatesan S, Dastidar DG Tags: Perspect Biol Med Source Type: research

Hope in Medicine: Applying Multidisciplinary Insights.
Abstract Hope is a crucial aspect of human life and has been a topic of interest in many scholarly disciplines. The medical literature, however, has-with a few exceptions-failed to take account of conceptions of hope across other scholarly disciplines. Before exploring what makes hope a distinctive and important phenomenon in medical contexts, this article reviews prominent views on hope from philosophy, anthropology, theology, and psychology. To synthesize these different conceptions, the authors propose an integrative approach aimed at improving the understanding of hope in medicine. The authors use a modes-of-h...
Source: Perspectives in Biology and Medicine - November 27, 2019 Category: Medical Ethics Authors: Kube T, Blease C, Ballou SK, Kaptchuk TJ Tags: Perspect Biol Med Source Type: research

Personalized, Precision, and < i > N < /i > -of-One Medicine: A Clarification of Terminology and Concepts.
This article offers a terminological and conceptual delineation and presents a new approach to personal care that relies on understanding the system dynamics of an individual as opposed to relying on statistical associations. A clarification of these terms and concepts is necessary to comprehend the vision of 21st-century medicine that will harness big data to deliver "scientific wellness" for individuals. PMID: 31761797 [PubMed - in process] (Source: Perspectives in Biology and Medicine)
Source: Perspectives in Biology and Medicine - November 27, 2019 Category: Medical Ethics Authors: Huang S, Hood L Tags: Perspect Biol Med Source Type: research

Care Labor in VAD Therapy: Some Feminist Concerns.
Abstract Ventricular assist device (VAD) care offers a distinctive lens through which we can explore unjust gender norms. This is a resource-intensive intervention, one in which increasingly sophisticated technology brings with it the need for more long-term care. This care work is demanding, involving device maintenance, medication and appointment management, household work, and emotional support. Most patients eligible for receiving VADs are men, so it is not surprising that it is more often women who are responsible for the care of patients with VADs. Still, there is room to question why so much of this labor i...
Source: Perspectives in Biology and Medicine - November 27, 2019 Category: Medical Ethics Authors: Campelia GD, Barg FK, Kirkpatrick JN, Hull SC Tags: Perspect Biol Med Source Type: research

The Challenge of Mutual Disclosure in Global Health Partnerships.
Abstract Institutional partnerships in global health, those contractual relationships involving institutions from the Global North and the Global South for purposes of public health enhancement and academic research, often fail to live up to the expectations held by all parties involved. The literature generally argues that inequities are the main concern in global health partnerships. We break with previous analyses by proposing a conceptual model to explain the frequently poor quality of the relationships based on aspects of sameness between the parties, or what we call symmetries in the relationship. We suggest...
Source: Perspectives in Biology and Medicine - November 27, 2019 Category: Medical Ethics Authors: Taylor LA, Berg DN Tags: Perspect Biol Med Source Type: research

Heuristics and Explanation in Translational Medicine.
Abstract The reigning paradigm of rational drug discovery in translational medicine attempts to exploit biological theories and pathophysiological explanations to identify novel drug targets and therapeutic strategies. Yet because many theories in medicine are either incomplete (at best) or false (at worst), relying on theoretical explanations can have some puzzling and troubling consequences. New drugs may be shown to be effective in clinical trials and receive regulatory approval despite a faulty explanation for why they are effective. If physicians rely on this explanation to make treatment decisions, it can le...
Source: Perspectives in Biology and Medicine - November 27, 2019 Category: Medical Ethics Authors: Hey SP Tags: Perspect Biol Med Source Type: research

Frosted Intellectuals: How Dr. Leo Kanner Constructed the Autistic Family.
This study is the first to compare Kanner's famous published case studies with case records of his patients in the Phipps Clinic at Johns Hopkins in order to discover how this stereotype was created. Contrary to his assertion in the published literature, Kanner did indeed see patients with autism whose parents who did not fit his stereotype, but he did not publish these cases. Kanner's stereotype of the "autistic parent" thus seems to have arisen through a process of confirmation bias. This continues to have ramifications to the present day, by linking autism in the popular mind to highly educated and professiona...
Source: Perspectives in Biology and Medicine - November 27, 2019 Category: Medical Ethics Authors: Sterwald C, Baker J Tags: Perspect Biol Med Source Type: research

< i > Frankenstein < /i > as Cautionary Tale for Medical Humanities? A Brief Coda.
Frankenstein as Cautionary Tale for Medical Humanities? A Brief Coda. Perspect Biol Med. 2019;62(4):710-716 Authors: Jones AH Abstract Amidst the recent bicentennial celebrations of the first publication, in 1818, of Mary Godwin Shelley's novel Frankenstein, little attention was given to the character Henry Clerval. Yet despite his few pages in the novel, Clerval's role as a humanist foil for Victor Frankenstein is significant. This brief coda examines what contemporary readers might learn from Clerval when his character is read allegorically, and how his presence in the novel makes clear that it can ...
Source: Perspectives in Biology and Medicine - November 27, 2019 Category: Medical Ethics Authors: Jones AH Tags: Perspect Biol Med Source Type: research

Ethical Implications for Potential Placebo Effects of Point of Care Ultrasound.
Abstract Anecdotally, practitioners of point of care ultrasound (POCUS) describe instances where patients appear to experience a placebo-like response after the examination, also described as a positive care effect. Extensive study of therapeutic ultrasound has yet to reveal differences between intervention and placebo, both of which respond to therapy. Indeed, POCUS is exemplary in incorporating many components known to modulate placebo-like effects. Patient expectations, ritualistic aspects of hands-on care, symbolic power of sophisticated medical instruments, the power of real-time POCUS images, therapeutic pra...
Source: Perspectives in Biology and Medicine - November 27, 2019 Category: Medical Ethics Authors: Scales D Tags: Perspect Biol Med Source Type: research

Metastatic Metaphors: Poetry, Cancer Imagery, and the Imagined Self.
Abstract How do metaphors shape and reflect patients' experience of cancer? How can repeated immersion in challenging poetry affect our understanding of cancer and other diseases? This essay addresses these two questions through an exploration of the varied and sometimes contradictory metaphors crafted by poet and seven-time cancer patient Judy Rowe Michaels. Although cancer is often regarded as an enemy intrusion to be eradicated, it is an illness in which the threat to life comes from within the self. Michaels's metaphors complicate the relationship between an embodied self and the cancerous cells the body produ...
Source: Perspectives in Biology and Medicine - November 27, 2019 Category: Medical Ethics Authors: Leveen L Tags: Perspect Biol Med Source Type: research

How I Thought Myself into Illness, Then Thought My Way Out.
Abstract When doctors couldn't find an explanation for my mysterious symptoms, including back pain, aching joints, and tingling limbs, I went on a quest to uncover the root causes. My journey took me from the West Coast to the East Coast, from physical therapists to psychiatrists, from the body to the mind, chronic pain to repressed emotions, existential crisis to posttraumatic growth. PMID: 31761805 [PubMed - in process] (Source: Perspectives in Biology and Medicine)
Source: Perspectives in Biology and Medicine - November 27, 2019 Category: Medical Ethics Authors: Grinnell D Tags: Perspect Biol Med Source Type: research

How Ought Health Care Be Allocated? Two Proposals.
Abstract Two thinkers have crafted visions of how they believe health-care resources ought to be allocated if there were universal health-care coverage in the United States. One is The Ends of Human Life (1994), in which Ezekiel Emanuel proposes to base resource allocation on community preferences. More recently, Charlene Galarneau has written Communities of Health Care Justice (2016), partly in response to Emanuel's earlier work. Both thinkers center their visions of just health care on communities, albeit differently structured from one another. This essay examines the similarities and differences in their propo...
Source: Perspectives in Biology and Medicine - November 27, 2019 Category: Medical Ethics Authors: Green EG, Truog R, Boyd JW Tags: Perspect Biol Med Source Type: research

What Is Cancer?
Abstract This essay focuses on themes in Explaining Cancer: Finding Order in Disorder (2018) by Anya Plutynski, a monograph that has important things to say about both the peculiarities of cancers and our theories about them. Cancer's agents of destruction are human cells that have been recruited and to some extent transformed into pathological organisms or the building blocks of tumors. Cancers both undermine and exploit mechanisms of multicellular organization, and understanding them gives rise to difficult philosophical problems. In addition to sketching Plutynski's discussion of these problems, this essay defe...
Source: Perspectives in Biology and Medicine - November 27, 2019 Category: Medical Ethics Authors: Hausman DM Tags: Perspect Biol Med Source Type: research

Editors' Introduction: < i > Examining Deeper Questions Posed by Disputes About Conscience in Medicine < /i > .
Editors' Introduction: Examining Deeper Questions Posed by Disputes About Conscience in Medicine. Perspect Biol Med. 2019;62(3):379-382 Authors: Curlin FA, Powell K PMID: 31495786 [PubMed - in process] (Source: Perspectives in Biology and Medicine)
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Curlin FA, Powell K Tags: Perspect Biol Med Source Type: research

Understanding Conscience as Integrity: < i > Why Some Physicians Will Not Refer Patients for Ethically Controversial Practices < /i > .
Understanding Conscience as Integrity: Why Some Physicians Will Not Refer Patients for Ethically Controversial Practices. Perspect Biol Med. 2019;62(3):383-400 Authors: Kaldjian LC Abstract The moral pluralism of Western democratic societies results in ethical differences among citizens and health professionals, due to contrasts between the foundational beliefs and values on which their ethical convictions rest. Some of these differences have challenging implications for the practice of medicine when a patient seeks access to a legal medical service that a conscientiously acting physician believes is ...
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Kaldjian LC Tags: Perspect Biol Med Source Type: research

Patients Need Doctors with Consciences.
This article argues that conscience is better understood as a feeling of integrity, rightness, and self, and that we need it especially now, as huge corporations take over health care. After an illustrative story, the author reviews the history of patients' rights and also the health-care consumer movement, which introduced the idea that health care is a commodity, and the doctor, therefore, simply a tradesman, whose duty is to provide what his patient wants. The author examines where this new commercial model of medicine leads: patients demanding treatments that are bad for them and expensive for the health-care system; d...
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Sweet V Tags: Perspect Biol Med Source Type: research

Integrity in Action: < i > Medical Education as a Training in Conscience < /i > .
Integrity in Action: Medical Education as a Training in Conscience. Perspect Biol Med. 2019;62(3):414-433 Authors: Eberly JB, Frush BW Abstract While conscience in medicine has been a source of debate for decades, the role of conscience in medical training remains largely unexamined. Insofar as conscience is addressed, trainees are typically urged to avoid practices that will conflict with their internal moral codes, refer to practitioners who will provide such practices, or even consider leaving the profession. This essay considers Lauris Kaldjian's articulation of two rival definitions of conscience...
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Eberly JB, Frush BW Tags: Perspect Biol Med Source Type: research

Alternatives to War Within Medicine: < i > From Conscientious Objection to Nonviolent Conflict About Contested Medical Practices < /i > .
Alternatives to War Within Medicine: From Conscientious Objection to Nonviolent Conflict About Contested Medical Practices. Perspect Biol Med. 2019;62(3):434-451 Authors: Nussbaum AM Abstract When we figure medical practice as warfare, an individual clinician may be either a dutiful combatant or a conscientious objector. The rhetorical structure of this choice means that clinicians may exercise their consciences by loyally joining or disloyally exiting the medical ranks' battle against disease. But there are alternatives to loyalty and exit, and within psychiatry, these alternatives have transformed c...
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Nussbaum AM Tags: Perspect Biol Med Source Type: research

Physicians' Refusals of Service on Grounds of Conscience.
Abstract What is conscience, and when should we let it be our guide? Only when it threatens indictment for nonadherence to an ethically valid duty? How do we know when that is? Doesn't conscience change? And shouldn't we change it intentionally sometimes, for example, on the basis of an all-things-considered judgment? Is conscience subject to reason-guided amendment? Mightn't it be immune to change based on a cost-benefit analysis? Isn't that its deontic characteristic? Suppose we can't help fearing conscience, should we be excused for knuckling under to it? Is conscience then a bully we can't evade? When should s...
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Stell LK Tags: Perspect Biol Med Source Type: research

Integrity and Conscience in Medical Ethics: < i > A Ciceronian Perspective < /i > .
Integrity and Conscience in Medical Ethics: A Ciceronian Perspective. Perspect Biol Med. 2019;62(3):470-488 Authors: Atkins JW Abstract In his work on medical ethics, Lauris Kaldjian identifies conscience with integrity. However, there are competing notions of integrity that may guide the conscience. This paper addresses debates over conscientious refusals by considering Cicero's account of integrity, a conception previously not discussed in the context of this debate. Cicero offers a framework for understanding integrity and conscience for the physician that is an alternative to Alasdair MacIntyre's ...
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Atkins JW Tags: Perspect Biol Med Source Type: research

Reasonable Accommodation of Conscientious Objection in Health Care Is Morally and Legally Required.
Abstract While mainstream, establishment medical journals have published opinion pieces condemning conscientious refusals in medical care, American law has consistently and repeatedly supported a right to such refusals. Law has not relied on a particular philosophical basis for health care. Indeed, legal precedents reject any monolithic model, whether based on consumerism or on professional obligations. Law focuses on the coexistence of diverse understandings, motivations, and delivery models. Scholarly approaches tend to ignore the fact that, fundamentally, conscientious objection involves a minority telling the ...
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Powell K Tags: Perspect Biol Med Source Type: research

When Deeply Held Personal Beliefs Conflict with Collective Societal Norms.
Abstract This essay analyzes the conflicts that arise between an individual's deeply held beliefs and the collective norms of society. Sometimes these conflicts are framed in religious terms. The author argues that such a framing is too narrow and inappropriately puts the focus on a specific set of (largely Christian) beliefs about matters related to sexuality. This essay attempts to broaden the discussion in order to highlight the ways in which conflicts between individual beliefs and practices, on the one hand, and prevailing societal norms, on the other, create the tension that can lead to societal change. ...
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Lantos JD Tags: Perspect Biol Med Source Type: research

Conscience, Moral Reasoning, and Skepticism.
Abstract There is much to admire in Lauris Kaldjian's explication of conscience and its uses for medical practitioners. Yet his claim that conscience is the final and best assessment of moral judgments is flawed, because it diminishes the influence of moral reasoning that balances and often corrects conscience. Skepticism about conscientious judgments is an important feature of ethics. Kaldjian's close linkage of conscience with moral integrity blunts the necessary recognition that one's conscience can be mistaken. His defense of physician refusals to refer patients gives insufficient weight to the idea that patie...
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Churchill LR Tags: Perspect Biol Med Source Type: research

Protecting Moral Integrity Through Justified Exemption.
Abstract Medical professionals have a duty to prioritize patient needs and well-being, even when doing so is deemed distasteful or unpleasant. This does not mean, however, that such professionals are obliged to provide medical interventions when participation threatens their core moral integrity. Myriad state and federal "conscience clause" statutes and regulations have codified such protections, but in a way that makes it too easy to claim exemption. This essay argues that, given professional obligations and systemic power asymmetries, the burden of proof falls upon professionals to show that participat...
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Meyers C Tags: Perspect Biol Med Source Type: research

Conscientious Objection, Moral Integrity, and Professional Obligations.
Abstract Lauris Kaldjian defends conscientious objection against opponents who claim that there is no place for a physician's personal moral beliefs in the practice of medicine. This essay argues that Kaldjian's defense of conscientious objection relies on a controversial "thick" conception of conscience that opponents may justifiably question. It offers a defense that relies on a relatively "thin" conception of conscience as an agent's core moral beliefs and that understands conscience-based refusals to provide medical services as refusals based on those core beliefs. Enabling physicians to pr...
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Wicclair MR Tags: Perspect Biol Med Source Type: research

Conscience and the Way of Medicine.
Abstract Disputes about conscientious refusals reflect, at root, two rival accounts of what medicine is for and what physicians reasonably profess. On what we call the "provider of services model," a practitioner of medicine is professionally obligated to provide interventions that patients request so long as the interventions are legal, feasible, and are consistent with well-being as the patient perceives it. On what we call the "Way of Medicine," by contrast, a practitioner of medicine is professionally obligated to seek the patient's health, objectively construed, and to refuse requests for ...
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Curlin FA, Tollefsen CO Tags: Perspect Biol Med Source Type: research

Bad Blood and Unsettled Law: < i > Are Healing and Justice Even Possible when Biocapitalism Prevails? < /i > .
Bad Blood and Unsettled Law: Are Healing and Justice Even Possible when Biocapitalism Prevails?. Perspect Biol Med. 2019;62(3):576-590 Authors: Pemberton S Abstract Eric Weinberg and Donna Shaw's Blood on Their Hands: How Greedy Companies, Inept Bureaucracy, and Bad Science Killed Thousands of Hemophiliacs (2017) belongs to a genre of underappreciated works that examine one of the greatest medical tragedies of the 20th century: the iatrogenic epidemics of HIV-AIDS among hemophilia patients. The book's focus on the legal fallout in the United States following this medical catastrophe typifies how and w...
Source: Perspectives in Biology and Medicine - September 11, 2019 Category: Medical Ethics Authors: Pemberton S Tags: Perspect Biol Med Source Type: research

Credit and Priority in Scientific Discovery: A Scientist's Perspective.
Abstract Credit for scientific discovery plays a central role in the reward structure of science. As the "currency of the realm," it powerfully influences the norms and institutional practices of the research ecosystem. Though most scientists enter the field for reasons other than desiring credit, once in the field they desire credit for their work. In addition to being a source of pleasure, credit and recognition are necessary for successful careers. The consensus among sociologists, philosophers, and economists is that pursuit of credit increases the efficiency of the scientific enterprise. Publishing ...
Source: Perspectives in Biology and Medicine - July 10, 2019 Category: Medical Ethics Authors: Flier JS Tags: Perspect Biol Med Source Type: research

The New Science of Practical Wisdom.
Abstract Wisdom has been discussed for centuries in religious and philosophical texts. It is often viewed as a fuzzy psychological construct analogous to consciousness, stress, and resilience. This essay provides an understanding of wisdom as a scientific construct, based on empirical research starting in the 1970s. The focus is on practical rather than theoretical wisdom. While there are different conceptualizations of wisdom, it is best defined as a complex human characteristic or trait with specific components: social decision-making, emotional regulation, prosocial behavior (such as empathy and compassion), se...
Source: Perspectives in Biology and Medicine - July 10, 2019 Category: Medical Ethics Authors: Jeste DV, Lee EE, Cassidy C, Caspari R, Gagneux P, Glorioso D, Miller BL, Semendeferi K, Vogler C, Nusbaum H, Blazer D Tags: Perspect Biol Med Source Type: research

Three Problems with Big Data and Artificial Intelligence in Medicine.
Abstract The rise of big data and artificial intelligence (AI) in health care has engendered considerable excitement, claiming to improve approaches to diagnosis, prognosis, and treatment. Amidst the enthusiasm, the philosophical assumptions that underlie the big data and AI movement in medicine are rarely examined. This essay outlines three philosophical challenges faced by this movement: (1) the epistemological-ontological problem arising from the theory-ladenness of big data and measurement; (2) the epistemological-logical problem resulting from the inherent limitations of algorithms and attendant issues of rel...
Source: Perspectives in Biology and Medicine - July 10, 2019 Category: Medical Ethics Authors: Chin-Yee B, Upshur R Tags: Perspect Biol Med Source Type: research

Concepts at the Bedside: Variations on the Theme of Autonomy.
This article examines the patient/clinician conversation when there is disagreement about the values at stake in the treatment decision. To set the stage for that examination, three cases of refusal of treatment are considered, which point to three ways of understanding the content and value of autonomy. In the patient/clinician conversation, the clinician must inevitably adopt one of these conceptions of autonomy, but if he or she adopts a conception that puts significant weight on having rationally defensible values determine the treatment decision, there is still a limit to how far the clinician may challenge the patien...
Source: Perspectives in Biology and Medicine - July 10, 2019 Category: Medical Ethics Authors: Brudney D Tags: Perspect Biol Med Source Type: research

The Problem of Female Genital Cutting: Bridging Secular and Islamic Bioethical Perspectives.
Abstract Recent events, including the arrest of physicians in Michigan, have renewed bioethical debates surrounding the practice of female genital cutting (FGC). The secular discourse remains divided between zero-tolerance activists and harm-reduction strategists, while Islamic bioethical debates on FGC similarly comprise two camps. "Traditionalists" find normative grounds for a minor genital procedure in statements from the Prophet Muhammad and in classical law manuals. "Reformers" seek to decouple FGC from Islam by reexamining its ethico-legal status in light of the deficiencies within narrat...
Source: Perspectives in Biology and Medicine - July 10, 2019 Category: Medical Ethics Authors: Duivenbode R, Padela AI Tags: Perspect Biol Med Source Type: research

Reconceiving Decisions at the End of Life in Pediatrics: Decision-Making as a Form of Ritual.
Abstract Medical anthropologists have long recognized that healing practices and rituals may seek to address family dynamics, alter roles within a community, and resolve social rifts, and that illness itself may be rooted in social and cultural concerns as much as physical and biological ones. Within this framework, decision-making for children at the end of life can be conceptualized as a type of healing ritual, directed not at physical healing of the individual body, but at the healing of a family, which will continue beyond the patient's death. Using this lens, the decision-making process becomes more important...
Source: Perspectives in Biology and Medicine - July 10, 2019 Category: Medical Ethics Authors: Caruso Brown AE Tags: Perspect Biol Med Source Type: research

"Undoing" Capacity: The Capability Approach in Pediatrics.
"Undoing" Capacity: The Capability Approach in Pediatrics. Perspect Biol Med. 2019;62(2):319-336 Authors: De Clercq E, Streuli J, Ruhe K, Elger BS Abstract Unlike adults, children are not granted the assumption of having decision-making capacity because their cognitive capacities are not yet fully developed. Still, child participation is increasingly encouraged within the clinical and research context. The trend towards inclusion has been initiated by the United Nations Convention on the Rights of Children (1989). The openness of the convention, however, might lead to contradictory interpret...
Source: Perspectives in Biology and Medicine - July 10, 2019 Category: Medical Ethics Authors: De Clercq E, Streuli J, Ruhe K, Elger BS Tags: Perspect Biol Med Source Type: research

Encounters of a Different Kind.
PMID: 31281125 [PubMed - in process] (Source: Perspectives in Biology and Medicine)
Source: Perspectives in Biology and Medicine - July 10, 2019 Category: Medical Ethics Authors: Moazam F Tags: Perspect Biol Med Source Type: research