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Predicting Clinical Trial Results: A Synthesis of Five Empirical Studies and Their Implications
Perspect Biol Med. 2023;66(1):107-128. doi: 10.1353/pbm.2023.0006.ABSTRACTExpectations about future events underlie practically every decision we make, including those in medical research. This paper reviews five studies undertaken to assess how well medical experts could predict the outcomes of clinical trials. It explains why expert trial forecasting was the focus of study and argues that forecasting skill affords insights into the quality of expert judgment and might be harnessed to improve decision-making in care, policy, and research. The paper also addresses potential criticisms of the research agenda and summarizes ...
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: Jonathan Kimmelman David R Mandel Daniel M Benjamin Source Type: research

Past Is Prologue: Ethical Issues in Pediatric Psychedelics Research and Treatment
Perspect Biol Med. 2023;66(1):129-144. doi: 10.1353/pbm.2023.0007.ABSTRACTRecent clinical trials of psychedelic drugs aim to treat a range of psychiatric conditions in adults. MDMA and psilocybin administered with psychotherapy have received FDA designation as "breakthrough therapies" for post-traumatic stress disorder (PTSD) and treatment-resistant depression (TRD) respectively. Given the potential benefit for minors burdened with many of the same disorders, calls to expand experimentation to minors are inevitable. This essay examines psychedelic research conducted on children from 1959 to 1974, highlighting methodologica...
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: Gail A Edelsohn Dominic Sisti Source Type: research

Historical Lessons on Vaccine Hesitancy: Smallpox, Polio, and Measles, and Implications for COVID-19
This study examines the history of US vaccination efforts against smallpox, polio, and measles, highlighting persistent drivers of vaccine hesitancy as well as factors that helped overcome it. The research reveals that logistical barriers, negative portrayals in the media, and fears about safety stymied inoculation efforts as early as the 18th century and continue to do so. However, vaccine hesitancy has been markedly diminished when trusted community leaders have guided efforts, when ordinary citizens have felt personally invested in the success of the vaccine, and when vaccination efforts have been tied to broader projec...
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: J J Eddy H A Smith J E Abrams Source Type: research

Narratives of Space and Time in Multiple Sclerosis Diagnosis
This article examines the complexity of narratives of space and time which support the diagnosis of multiple sclerosis, and the consequences for patients disadvantaged by deficits in social cognition or socioeconomic status in areas relating to literacy. In the context of demonstrating the significance of narratives of space and time in the diagnostic process for multiple sclerosis, the article discusses new strategies for treatment that engage the arts and humanities and presents a brief history of the disease and current diagnostic criteria, before discussing the MS Society of Great Britain and Ireland's awareness and fu...
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: Paula Leverage Source Type: research

A Heresy of No Consequence: Duties and Virtues in Medicine and Professionalism
Perspect Biol Med. 2023;66(1):179-194. doi: 10.1353/pbm.2023.0010.ABSTRACTIn The Trusted Doctor: Medical Ethics and Professionalism (2020), Rosamond Rhodes presents a new theory of medical ethics based on 16 duties she considers central to medical ethics and professionalism. She asserts that her theory is "bioethical heresy," as it contradicts established "principlism" and "common morality" approaches to ethics in medicine. Rhodes advocates the development of parallelism between clinical and ethical decision-making and a systematic approach that emphasizes duties over principles and rules to facilitate the development of a...
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: Vincent Kopp Source Type: research

Living Donor Ethics and Uterus Transplantation
This article provides an in-depth ethical analysis of living donor uterus transplantation, incorporating clinical, psychological, and qualitative study data into the discussion. Although the concept of living organ donors as patients in their own right has not always been present in the field of transplantation, this conceptualization informs the framework for living donor ethics that we apply to living uterus donation. This framework takes root in the principles of research ethics, which include respect for persons, beneficence, and justice. It incorporates an analysis based on eight potential vulnerabilities of living do...
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: Anji E Wall Giuliano Testa Source Type: research

Organismal Superposition Problem and Nihilist Challenge in the Definition of Death
Perspect Biol Med. 2024;67(1):1-21. doi: 10.1353/pbm.2024.a919707.ABSTRACTAccording to the mainstream bioethical stance, death constitutes the termination of an organism. This essay argues that such an understanding of death is inappropriate in the usual context of determining death, since it also has a social bearing. There are two reasons to justify this argument. First, the mainstream bioethical definition generates an organismal superposition challenge, according to which a given patient in a single physiological state might be both alive and dead, like Schrödinger's cat. Therefore, there is no clear answer as to whet...
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: Piotr Grzegorz Nowak Source Type: research

Organismal Superposition and Death
Perspect Biol Med. 2024;67(1):22-30. doi: 10.1353/pbm.2024.a919708.ABSTRACTOrganismal superposition holds that the same individual both is and is not an organism, as a consequence of organismal pluralism. When coupled with the assumption that death is the cessation of an organism, this entails that there is no unique answer as to whether brain death is biological death. This essay argues that concerns about organismal pluralism and superposition do not undermine a theory of biological death, nor entail any metaphysical indeterminacy about the biological vital status of a brain-dead individual.PMID:38662061 | DOI:10.1353/pb...
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: Michael Nair-Collins Source Type: research

"Inherently Limited by Our Imaginations": Health Anxieties, Politics, and the History of the Climate Crisis
Perspect Biol Med. 2024;67(1):31-62. doi: 10.1353/pbm.2024.a919709.ABSTRACTAs global warming became a cause of concern in the 1980s, researchers and climate activists initially paid little attention to the possible health effects of a warmer world. This changed quickly between 1985 and 1989, when scientists working on contracts with the US Department of Energy and the Environmental Protection Agency extrapolated from existing knowledge about the impact of weather on health to speculate about how global warming would impact health. However, they downplayed the impact of their contributions by highlighting the uncertainty in...
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: David Shumway Jones Source Type: research

Bios-Ethics and the Bios Emergency: Finding the Real Work
This article presents a case for transforming traditional bioethics into "Bios-ethics." This exposition relies on three propositions: (1) the climate emergency is the "Bios emergency"; (2) in the Bios emergency, bioethics must be replaced by Bios-ethics; and (3) the top and overwhelming priority of Bios-ethics is to address the Bios emergency. Biocentrism, habitat, and environmental ethics are discussed in light of their contribution to the development of Bios-ethics, and potential lines of research in Bios-ethics are outlined. The urgency of undertaking substantive conceptual and practical innovations in response to our c...
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: David Schenck Source Type: research

Euthanasia and End-of-Life Decisions: From the Empirical Turn to Moral Intuitionism
This article employs a "revisionary" intuititionist perspective to discuss the results of a clinical ethics study about intensivists' perceptions of withhold or withdraw decisions. The results show that practitioners' moral experience is at odds with both the discontinuity and equivalence theses. This outcome allows us to revisit certain concepts, such as intention and causal relationship, that are prominent in the conceptual debate. Intensivists also regard end-of-life decisions as being on a scale from least to most active, and whether they regard active forms of end-of-life decisions as ethically acceptable depends on t...
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: Marta Spranzi Source Type: research

Diagnosis: What Is the Structure of Its Reasoning?
Perspect Biol Med. 2024;67(1):88-95. doi: 10.1353/pbm.2024.a919712.ABSTRACTHow does the diagnosis process work? This essay traces the philosophical underpinnings of diagnosis from Hume through Kant, Peirce, and Popper, analyzing how pathologists amalgamate sensibility, intuition, and imagination to form new hypotheses that can be tested by evidence and experience.PMID:38662065 | DOI:10.1353/pbm.2024.a919712 (Source: Perspectives in Biology and Medicine)
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: Donald E Stanley Robert Hanna Source Type: research

Lived Religion in Religious Vaccine Exemptions
Perspect Biol Med. 2024;67(1):96-113. doi: 10.1353/pbm.2024.a919713.ABSTRACTThis essay explores a more inclusive and equitable interpretation of "religion" within the context of religious vaccine exemptions. The existing literature critiques the prevalent interpretation of the meaning of religion in religious exemption cases, but frequently overlooks the importance of incorporating the concept of "lived religion." This essay introduces the concept of lived religion from religious studies, elucidates why this lived religion approach is crucial for redefining "religion," and illustrates its application in the domain of relig...
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: Hajung Lee Source Type: research

Introduction to the Special Section on Psychedelics Research and Treatment
Perspect Biol Med. 2024;67(1):114-116. doi: 10.1353/pbm.2024.a919714.NO ABSTRACTPMID:38662067 | DOI:10.1353/pbm.2024.a919714 (Source: Perspectives in Biology and Medicine)
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: Dominic Sisti Source Type: research

Bio-Psycho-Spiritual Perspectives on Psychedelics: Clinical and Ethical Implications
Perspect Biol Med. 2024;67(1):117-142. doi: 10.1353/pbm.2024.a919715.ABSTRACTPsychedelics have again become a subject of widespread interest, owing to the reinvigoration of research into their traditional uses, possible medical applications, and social implications. As evidence for psychedelics' clinical potential mounts, the field has increasingly focused on searching for mechanisms to explain the effects of psychedelics and therapeutic efficacy of psychedelic-assisted therapy (PAT). This paper reviews three general frameworks that encompass several prominent models for understanding psychedelics' effects-specifically, ne...
Source: Perspectives in Biology and Medicine - April 25, 2024 Category: Medical Ethics Authors: Logan Neitzke-Spruill Nese Devenot Dominic Sisti Lynnette A Averill Amy L McGuire Source Type: research