The American journal of bioethics : AJOB最新文献

{"title":"The Place of Philosophy in Bioethics Today? Ancestry Counts.","authors":"Margaret P Battin","doi":"10.1080/15265161.2022.2134501","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134501","url":null,"abstract":"","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"25-27"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bioethics Consultation and First-Order Moral Reasoning: Leaving Philosophy at the Hospital Doors.","authors":"Dave Langlois, Jeremy Butler","doi":"10.1080/15265161.2022.2134487","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134487","url":null,"abstract":"Barby-Blumenthal et al. (2022) argue that academic philosophy still has important contributions to make to bioethics. We agree with some and disagree with many of their claims. In this commentary, however, we address philosophy’s relationship with a specific branch of bioethics, namely clinical bioethics consultation (CBC), which the authors say little about. We agree with the authors that bioethics (including in the context of CBC) cannot rest on the rote application of pre-established theoretical work in ethics. Indeed, against the consensus among scholars at the recent conference the authors describe, we think this is as true of CBC as it is of the more abstruse issues the authors mention, such as the nature of consciousness, agency, and personal identity. In our view, CBC consisting of the mere application of prefab frameworks, such as the sacred “four principles” (Beauchamp and Childress 2019), is bad CBC. However, we also believe–in contrast to the authors’ claim that “people should view philosophers as a potential source of moral guidance on what the right (or wrong) thing to do is in a particular situation” (Blumenthal-Barby et al. 2022, 19)—that advanced training in philosophy has little relevance to CBC. This is because philosophical (and even moral-philosophical) expertise does not contribute to the knowledge and skills necessary to support clinicians in first-order moral reasoning. In our view, and consistent with established views in the field (e.g., ASBH 2011), the central aim of CBC is to support persons in the clinical environment as they engage in challenging instances of first-order moral reasoning. By \"first-order moral reasoning\" we mean the kind of moral reasoning that all persons unavoidably engage in throughout their daily lives as socially, professionally, legally, and politically situated moral agents. The term \"first-order\" distinguishes this form of moral reasoning from those that are, or contain elements of, reasoning about moral reasoning (i.e., secondor higher-order moral reasoning). Moral agents are faced with first-order questions like: should I euthanize my beloved companion animal now that she is gravely unwell? Should I speed in my car to get my child to the airport on time, so that he can visit his dying grandmother? Should I buy this t-shirt, given what I know about how this company produces its clothing? Should I tell Marcia that Tim has joined a known cult, despite the fact that doing so would violate Tim’s trust? First-order moral reasoning in the clinical setting is contextually different than that which occurs in other social and professional contexts, but it is first-order moral reasoning nonetheless. Moral questions in the clinical setting have no special philosophical salience or significance. They are rarely “general,” in the philosophical sense of that word; they do not concern the moral permissibility of broad categories of actions and they do not turn on metanormative or theoretical considerations ","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"41-43"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"History of Racism in Healthcare: From Medical Mistrust to Black African-American Dentists as Moral Exemplar and Organizational Ethics-a Bioethical Synergy Awaits.","authors":"Carlos Stringer Smith","doi":"10.1080/15265161.2022.2105588","DOIUrl":"https://doi.org/10.1080/15265161.2022.2105588","url":null,"abstract":"Racism as a contributing factor to health disparities and inequities has long been understood and established. Recently, scholars, professional organizations and even the public at large have made a clarion call that racism is, in and of itself, an actual public health issue (Wright et al. 2020). In fact, scholars have named racism itself as a social determinant of health (Yearby 2020). In uncovering the many aspects of the history of racism in healthcare, one does not have to look far to encounter one of the remaining vestiges of such years gone by. The issue of medical mistrust, particularly amongst our most vulnerable populations, remains a current bioethical issue today. In fact, mistrust of academic and research institutions and investigators is the most significant attitudinal barrier to research participation reported by African Americans (Scharff et al. 2010). The intersection of healthcare professionals’ ethics, or the lack thereof, along with the continued modern zeal for interprofessionalism among varying clinical providers is most powerfully witnessed at the doorstep of a seemingly most unlikely of places: America’s Black dentists. Roughly accounting for a mere 3.8% of America’s dentists (Wright, Vujicic, and Frazier-Bowers 2021), Black dentists treat more underserved and vulnerable patients, carry more educational debt load, and experience a detrimental amount of discrimination in pursuit of their dental education and careers, with more than 86% of Black dentists reporting discriminatory experiences (Wright, Vujicic, and Frazier-Bowers 2021; Mertz et al. 2017; Fleming et al. 2022). Yet the fact remains, Black dentists lay claim to a lineage of one of the most significant breakthroughs throughout America’s centuries enduring battle of access to equitable and just healthcare. In 1962, George Simkins Jr., a Greensboro dentist, and other black dentists, physicians, and patients filed a lawsuit claiming federal support for the Moses H. Cone Memorial Hospital and Wesley Long Hospital, local institutions that served only white patients, was unconstitutional (Reynolds 1997, Oral History Interview with George Simkins 1997). (One of Simkins’ patients had an abscessed tooth and needed surgery; Greensboro’s black hospital didn’t have space for him and the whites-only hospitals refused to treat him.) While the plaintiffs initially lost, they appealed, resulting in the Supreme Court decision, Simkins v. Moses H. Cone Hospital, that set in motion the desegregation of hospitals throughout the South. Despite decades and centuries long discriminatory treatment, somehow Black dentists have been a living emobidiment of altruism and entrenching a legacy as moral exemplars in a world and professional environment oft designed to instill just the opposite. The history of racism in healthcare has often, and rightly so, centered the experiences of patient exploitation, abuse and, at times, downright disregard for the humanity of those from historically minort","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"7-9"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40645914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bioethics is Philosophy.","authors":"Rosamond Rhodes, Gary Ostertag","doi":"10.1080/15265161.2022.2134499","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134499","url":null,"abstract":"In their target article, Blumenthal-Barby et al. (2022) address the view that bioethics as a philosophical discipline is obsolete. Indeed, their discussion was prompted by a recent bioethics conference’s plenary session on the obsolescence of bioethics. While the speakers, including several leading bioethicists, acknowledged the essential work that philosophers had provided in establishing the basic principles of the discipline, they also held that further work was no longer necessary. In brief, they maintained that: the foundations have been set, the questions identified, the solutions tabulated. Bioethics today consists of merely the application of “existing philosophical principles or concepts.” Philosophers can step aside. The conference speakers were not voicing a minority view. We thus agree with Blumenthal-Barby et al. that a decisive rejection of what we’ll refer to as bioethics eliminativism is called for. While we are largely in agreement with their defense of the enduring importance of philosophical bioethics, more needs to be said. In particular, we address a lingering misunderstanding of what philosophers do and thereby demonstrate what makes bioethics a philosophical discipline as opposed to an autonomous discipline, one where philosophers’ input is no longer relevant. As we understand their position, bioethics eliminativism maintains two theses:","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"22-25"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking the Role of Experimental Philosophy in Bioethics.","authors":"Gonzalo Díaz-Cobacho, Ivar R Hannikainen","doi":"10.1080/15265161.2022.2134494","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134494","url":null,"abstract":"sion that are affected by constraint. This pushes clients who have not decided to give up their profession to think hard of what the new meaning of their continued practice would look like. If they continue practicing with their professional guiding values constrained, they are faced with the hard question of making new sense of their practice despite the broken integrity by finding new values that help them rediscover integrity. The wellbeing and resilience of healthcare professionals we benefit through philosophy are at stake in the face of many difficulties they are facing as aggravated by the long pandemic. This is more reason why it is important that philosophy plays this “other” role described above and use resources from all available traditions or branches of philosophy, including helpful existentialist influenced approaches to philosophizing.","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"69-72"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Philosophers in Bioethics.","authors":"Joona Räsänen, Matti Häyry","doi":"10.1080/15265161.2022.2134485","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134485","url":null,"abstract":"there is no answer to the question of what death “really” is. This kind of possibility is one of the issues discussed recently under the heading of “conceptual engineering” (see, e.g., Burgess, Plunkett, and Cappelen 2020), and it may provide further opportunities for convergence in bioethics. Perhaps we should accept that both concepts, or, if you prefer, “conceptions” of death are potentially helpful; and there is no reason why we should not use both, depending on context. What if disagreement still remains, on theories, concepts, implications, and so on? At this point, bioethicists should recognize that the decision of how to proceed outside the philosophical study is not just an epistemic, but a normative or moral question. There are standard Condorcet-based reasons for thinking that the broader any ethical discussion can be made, other things equal, the stronger the chance of progress and convergence. So once bioethicists have made clear what the issues are— what concepts are in play, and how they can be understood; what practical options are on the table; what various forms of consequentialism and deontology say about them; and so on—they have what we might call a “duty” properly to inform all stakeholders of the issues so that they can decide how to take things forward. Bioethics is itself an ethical enterprise; and the contribution it has been making, and should continue to make, is to the ongoing open and democratic conversation of humanity as a whole about how we should live and act, individually and as a species.","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"58-60"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rejection of \"Applied Ethics\": Philosophy's Real Contributions to Bioethics Found Elsewhere.","authors":"Ryan Marshall Felder, David Magnus","doi":"10.1080/15265161.2022.2140539","DOIUrl":"https://doi.org/10.1080/15265161.2022.2140539","url":null,"abstract":"This month’s Target Article by Blumenthal-Barby et al. (2022) offers a defense of the importance of philosophy to bioethics. The authors cite the crucial role of philosophers in the development and application of theories, principles, and concepts, such as the Doctrine of Double Effect (DDE) to concrete problems in bioethics. We are skeptical of these claims for reasons articulated by both Banja (2022) and Fedyk (2022) in their commentaries and that were well articulated by Art Caplan many years ago (Caplan 1980). Principles and theories aren’t “applied” in any straightforward sense, in either the sciences or in moral problem solving. Take as an example our experiences of theoretical under-determination of theories of justice in the context of COVID resource allocation committees. We were asked to assist in applying theories of justice and principles of bioethics to concrete problems of allocation of scarce vaccines and drugs, but we soon discovered that any attempt to apply a theory required us to move so far away from the theory itself that we weren’t so much “applying” a theory as we were simply offering a morally-flavored answer to the allocation questions. Although there is a sense in which bioethicists can introduce some ethical flavor to conversations like that, it is not an application of a principle or theory in any obvious sense. Or, more directly, the authors believe that DDE and its distinction between intentional harms and non-intentional, yet foreseeable harms can aid in answering important questions surrounding medical aid in dying. Even if it is true that attempts to apply DDE cannot overlook the rich philosophical literature on that topic, it is not clear that any version of DDE that is sophisticated enough to withstand scrutiny according to the standards of analytic philosophy would be simple enough to be wielded by non-specialists without having its content watered down. Alternatively, any version of DDE simple enough to be used in that context would not require the input of philosophers. In other words, even granting that theories are applied, it is not clear that applied philosophical ethics in this sense will be able to strike the right balance between theoretical correctness and parsimony. Hence, underdetermination is likely to remain in this realm despite philosopher’s best efforts. We particularly appreciate Fedyk’s appeal to philosophy of science and philosophy of biology for a potentially more fruitful model of philosophical contributions to bioethical problem solving. At the same time, this approach highlights some of the limitations of bioethics being done by scholars in philosophy departments. As a journal editor, one of us often sees work that is well argued, but misguided, because it is based upon false assumptions as a result of ignorance of the real world of medicine or science (e.g., conflating two very different technologies so that the arguments being made don’t apply to either). Just as it is not possible to ","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"1-2"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bioethicist Position Available: Philosophers Need Not Apply.","authors":"John Banja","doi":"10.1080/15265161.2022.2134484","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134484","url":null,"abstract":"Sometimes Blumenthal-Barby et al. (2022) discuss the philosopher’s contribution to bioethics as a largely theoretical or apriori one that arrives from out of the blue—like Parfit’s identity theory—and is subsequently appropriated by bioethicists for their own work. At other times, the authors seem to represent the academic philosopher (AP) as one who transitions from Plato’s world of forms to the messy, culturally embedded, realworld dilemmas with which bioethicists grapple every day. In this essay, I’m more interested in the former, “pure” philosopher account rather than the philosopher-journeyman one, such as when philosophers transmogrify into full-time medical ethicists or neuroethicists. Accordingly, this essay addresses the question as to what special expertise a philosopher qua philosopher might have, distinct from scholars in law, medicine, investigative journalism, political science, gender studies, economics, etc., that is of unique value to bioethics. I shall argue that the answer is none. In fairness, Blumenthal-Barby et al. acknowledge that possibility but don’t take it on. I will. In what follows, I’ll offer three arguments that shamelessly borrow from Tristram Engelhardt’s and Richard Rorty’s deflationary accounts of the Western philosophical canon and recall what more than a few philosophers have recently admitted: that despite millennia of effort, philosophy has made next to no progress in answering Plato’s “big” questions, and that there is little prospect for change (Chalmers 2015; Dietrich 2011; Shand 2017). If true, then it is hard to see how bioethics or any other “applied” scholarly discipline can benefit from philosophers’ distinctly “philosophical” reflections.","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"30-33"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Disconnection That Wasn't: Philosophy in Modern Bioethics from a Quantitative Perspective.","authors":"Piotr Bystranowski, Vilius Dranseika, Tomasz Żuradzki","doi":"10.1080/15265161.2022.2134490","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134490","url":null,"abstract":"Blumenthal-Barby and her colleagues (2022) situate their discussion of philosophy and bioethics in the context of (reportedly) widely held assumption that, when compared to the early days of bioethics, the role of philosophy is now diminished across the field – the assumption we call the Disconnection Thesis . This assumption can be summarized, to use the authors’ own words, by the phrase “philosophy’s glory days in bioethics are over“. While in no place of the article they explicitly endorse the Disconnection Thesis, at least some of the authors had previously endorsed it in print (Savulescu 2015). Such expressions of collective expert wisdom might be a valuable source of information on the discipline's history, but they should not be accepted uncritically. Given the explosion in the size and scope of bioethical research in recent decades, any scholar’s familiarity with the area is necessarily based on selective reading and might be biased. Hence, in this commentary, we examine what kind of more rigorous evidence could corroborate the Disconnection Thesis. In other words, if the role of philosophy in bioethics has been indeed diminishing, what kind of observable patterns should we expect to see? focus","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"36-40"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethics Consultation-A Blind Spot of Philosophy in Bioethics?","authors":"Dagmar Schmitz, Marcus Duewell","doi":"10.1080/15265161.2022.2134486","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134486","url":null,"abstract":"While making an important point for a strong role of philosophers and philosophical work in bioethics, Blumenthal-Barby and colleagues (2022) fail to mention one of the most pressing tasks in this field: a critique of ethics consultation (EC) in clinical settings. Since the early 1970s, a continuously growing number of health care institutions are complementing their teams with ethics consultants, who offer assistance whenever an uncertainty or a conflict arise about the ethically best course of action in clinical care (Tarzian and Force ASBH Core Competencies Update Task 2013). They work as single consultants or members of ethics committees and typically respond to requests of health professionals, patients or relatives in their institutions. Mainly the advances in intensive care and organ replacement therapies like mechanical ventilation have led to this development (Tapper 2013). With the availability of life-prolonging technology came the pressing question of justified criteria for their withdrawal. Physicians felt that their medical training did not provide all the instruments needed in such complex decision-making processes and it have been mostly philosophers like Albert Jonsen and John Fletcher, who in these early days of ethics consultation came to their aid (Tapper 2013). Since then, many medical and non-medical academics specialized in analyzing and weighing treatment options from an ethical point of view and, thus, contributed to the building of a new profession of ethics consultation. In 2018, 86.3% of all US general hospitals had an ethics consultation service (ECS) (Fox et al. 2022). Many other countries reported similar developments. What at first glance impresses as a success story, does reveal various inconsistencies at a closer examination. Not only is the actual utilization of ECSs still low. Fox and colleagues reported a median number of 3 case consultations per year for ECSs in the US (Fox et al. 2022). The data for other countries (if available) are similar. The whole practice is still characterized by an astonishing lack of evidence. We have little knowledge about by whom and how EC is offered and equally little about what are the ends and outcomes (Fox et al. 2022; Schildmann et al. 2019). Even more alarming are the deficiencies on the theoretical level. Regarding the normative framework of ethics consultation, the prevailing principlism in this context suffers from an oversimplification to an extent that its basic ideas are often barely recognizable. A principle like “autonomy,” for example, is not self-explanatory but there are important philosophical backgrounds that shape its meaning in ways that are relevant for the application in a concrete medical practice. Even if nobody expects an ethics consultant to have the entire history of this concept in mind, one should be able to deal with it to at least the extent that the most important meanings of the concept are present. On the other side of the spectrum of theories i","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"47-48"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}