The American journal of bioethics : AJOB最新文献

{"title":"Some Reflections on the Importance of Philosophy to Bioethics.","authors":"David DeGrazia","doi":"10.1080/15265161.2022.2134498","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134498","url":null,"abstract":"contrary, we could see it as the way philosophy has always worked, from Plato and Aristotle on, as concerned with conceptual issues, with normative issues, and especially with unrecognized assumptions that plague casual thought. Philosophy has been the generative parent while the infant bioethics was emerging; this progeny has now matured into a recognized and affluent, influential, and in many ways authoritative field. Can we see in the rich picture of bioethics that BB brings to bear a struggle to break free, to develop into a comparatively autonomous, independent party, to develop its own norms and practices? Tristram Engelhardt‘s prescient warning about the development of a “secular priesthood” should be always in our minds, that a field like bioethics, replacing as it does much of the moral discussion that had been going on in the churches, may become divorced from any religious project but nevertheless invested with “the mantle of knowing what is right.” BB’s thorough account of the ways in which philosophy is still needed and still operative in many of the most trenchant discussions in contemporary bioethics suggests that bioethics can best be viewed as the mature offspring of its parent philosophy, increasingly adult and capable, but–if it doesn’t calcify into “philosophy light” or rote applications of the four-principle so-called Georgetown Mantra—remains a lineal descendant, a full-fledged “field” in its own right but one that still lives with the fortunate DNA of its parent. In BB’s argument, despite the sometimes less fortunate “two fields” phrasing, I think philosophy isn’t dethroned at all; rather, philosophy’s continuing centrality in bioethics is warmly and appropriately recognized.","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"27-29"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490771","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 Future for Bioethics?","authors":"Roger Crisp","doi":"10.1080/15265161.2022.2134502","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134502","url":null,"abstract":"from within bioethics, philosophy is not a self-sufficient discipline—no discipline is. The significance of its arguments and concepts, no matter how sophisticated, should be appreciated and applied as a historical, dialectical process. Philosophy’s engagement with bioethics is as much about the development of the former as it is of the latter. The point here is not to understate the unique and critical importance of philosophy’s contributions to bioethics. Rather, our hope is that appreciating this dynamic might contribute to a more mutually constructive, respectful, and sustained engagement between philosophy and bioethics.","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"56-58"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490759","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 Philosophy After the Empirical Turn in Bioethics.","authors":"Suzanne Metselaar, Guy Widdershoven","doi":"10.1080/15265161.2022.2134493","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134493","url":null,"abstract":"In “The Place of Philosophy in Bioethics Today,” Blumenthal-Barby and colleagues argue that philosophy is indispensable to the field of bioethics (Blumenthal-Barby et al. 2022). Nonetheless, they identify an underrepresentation of philosophers in funded bioethics projects. They contrast “more foundational normative and conceptual work” with “typically funded empirical bioethics and preference surveys,” and quote a report that identifies the focus on empirical studies to be a weakness of funding organizations, as it disregards the importance of philosophical work. We do not deny the importance of more foundational normative and conceptual projects, and agree that not all bioethicists need to be doing practice-focused work. However, we argue that the empirical turn in bioethics as such does not make philosophy obsolete; rather, it implies a specific and indispensable role of philosophy. This only adds to the three arguments of Blumenthal-Barby et al.: The important role of philosophy in empirical bioethics is a fourth way in which philosophers remain highly relevant to the interdisciplinary domain that is bioethics. Empirical ethics is a general term for “methodologies that seek to use empirical data about stakeholder values, attitudes, beliefs and experiences to inform normative ethical theorizing” (Davies, Ives, and Dunn 2015). It departs from the assumption that exploring stakeholders’ views and experiences informs and enhances ethical analysis, as it makes ethicists more contextually aware and more grounded in the realities of lived experience, and provides better, more workable solutions for ethical problems (Leget and Borry 2010). In our view, the role of philosophy in empirical ethics is twofold. First, philosophical analysis can provide much-needed reflection on the methodological and epistemological presuppositions of empirical ethics. Second, philosophical work is needed in order to interpret empirical results and to come to normative conclusions. Let us first go into the role of philosophy regarding reflection on the presuppositions of empirical ethics. It has been argued that the very notion of empirical ethics is problematic, as it seems to be at odds with the is–ought distinction. How can factual statements about, for instance, stakeholder beliefs result in conclusions with normative force? Various ways have been proposed for taking into account stakeholder views in normative bioethics work (Musschenga 2005). One is the reflective equilibrium approach, in which the ethicist weighs the normative intuitions of stakeholders against other relevant normative considerations (Van Thiel and Van Delden 2009). Another is the dialogical approach, in which the ethicist organizes a process of deliberation with stakeholders in order to come to joint normative conclusions that are primarily consensus based (Widdershoven, Abma, and Molewijk 2009). However, methodologies in empirical ethics are diverse and evolving (Davies, Ives, and Dunn 2015). Thus,","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"49-51"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490760","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":"Exploring the \"Other\" Role of Philosophy in Bioethics: The Case of Addressing Moral Distress and Rediscovering Meaning and Purpose.","authors":"Allen Alvarez","doi":"10.1080/15265161.2022.2134495","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134495","url":null,"abstract":"These two ways correspond to other branches of philosophy implied in the article but not presented in the examples. There is a need to explicitly present these “other” role to intentionally include them in helping achieve a more comprehensive approach to continuing to integrate philosophy to the practice of bioethics, as argued by the authors. While there is a need to help resolve perplexity about big issues that impact how professionals make ethical decisions, e.g. defining “death,” “interests”, etc., philosophy has another role to play to help professions chronically affected by moral distress. Philosophers who serve as clinical ethicists can provide live bioethical analysis in close proximity to the user of that analysis as well as help those who experience moral distress to make sense of how they can still live with integrity. Blumentahal-Barby et al. (2022) made a compelling point that the many branches of philosophy still have a very meaningful and important role to play in the field of bioethics. The reasons and examples they presented are convincing and clearly show how bioethics “practice” can continue to be significantly edified by the conceptual and analytic contributions of philosophical inquiry. Simple application of past theoretical contributions of philosophy is not enough as the need to continue moving back and forth between considered judgments and theoretical/conceptual understanding of guiding norms persists in practice. The five concrete suggestions offered toward the end of their article (Blumentahal-Barby et al. 2022, 11–14) can help realize the need to unleash the potential of philosophy to make significant impact. They pertain to the need for philosophers who practice in bioethics centers to continue to engaging philosophy (suggestion 3), philosophers who study bioethics to engage bioethics Centers (suggestion 4) and philosophers who teach in professional schools should teach good philosophy instead of using the typical “philosophy light approach” to teaching bioethics (suggestion 5). Even if philosophers can take these suggestions and realize them in practice, the content, scope of philosophical approaches and methods of analysis need not be confined to only one tradition. It seems that the style/tradition of philosophy the authors accounted for only covered the analytic kind of philosophizing, i.e. analysis of principles, concepts and theories in the face of ethical issues. While both analyticand continental-trained philosophers are experts in doing analysis as presented in the examples reviewed by the authors, analysis is NOT the only legitimate way to do philosophy! Philosophers who are hired as clinical ethicists sometimes need to provide support to those who are not experiencing uncertainty due to a moral dilemma but rather experiencing constraints on what they believe to be the right thing to do. In view of this, there is also a need to explore the “other” role of philosophy that goes beyond bioethical analysis from","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"67-69"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490762","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, Philosophy, and Philosophy of Disability.","authors":"C Dalrymple-Fraser","doi":"10.1080/15265161.2022.2134496","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134496","url":null,"abstract":"Blumenthal-Barby et al. (2022) list several areas of philosophy that may contribute to bioethics. Missing from their list and explicit discussion is the philosophy of disability. Whereas mainstream bioethics and philosophy have been criticized for their treatment and portrayal of disability and disabled people, this exclusion is lamentable, particularly given the examples the authors discuss. Meanwhile, philosophers of disability have often contributed to bioethics, as demonstrated in the inaugural 2021 issue of the Journal of Philosophy of Disability and the 2021 “Philosophies of Disability and the Global Pandemic” issue of the International Journal of Critical Diversity Studies. This commentary supports the authors’ general position while addressing this omission by outlining three ways in which engagement with philosophy of disability stands to benefit bioethics. Two initial clarifications. First, “philosophy of disability” here refers to the subdiscipline of philosophy focused on disability, similar to how “philosophy of mind” or “philosophy of biology” pick out their topics of mind and biology respectively. Second, while philosophy of disability is excluded from the authors’ explicit discussions, it is not entirely absent from the article: their citations engage philosophy of disability, and several authors also do so in their other works. But this does not preclude a need for more direct engagement here, particularly given that disability appears explicitly in their examples of disability classification, abortion of putatively disabled fetuses, and prosthetic embodiment. Philosophy of disability thus seems relevant both generally and locally to their article.","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"64-66"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490764","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":"How Philosophy of Science Can Unlock New Methods in Bioethics.","authors":"Mark Fedyk","doi":"10.1080/15265161.2022.2134492","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134492","url":null,"abstract":"dignity in end-of-life decisions. Ethical Perspectives 17 (2):231–52. doi:10.2143/EP.17.2.2049265. Metselaar, S., and G. Widdershoven. 2019. Moral dilemmas in (not) treating patients who feel they are a burden. Bioethics 33 (4):431–38. doi:10.1111/bioe.12579. Molewijk, B. 2004. Integrated empirical ethics: In search for clarifying identities. Medicine, Health Care and Philosophy 7 (1):85–91. doi:10.1023/B:MHEP.0000021851. 43585.26. Musschenga, A. W. 2005. Empirical ethics, contextsensitivity, and contextualism. The Journal of Medicine and Philosophy 30 (5):467–90. doi:10.1080/0360531 0500253030. Niv, Y., and R. Sulitzeanu-Kenan. 2022. An empirical perspective on moral expertise: Evidence from a global study of philosophers. Bioethics :1–10. doi:10.1111/bioe. 13079. Van Thiel, G. J. M. W. and J. J. M. Van Delden. 2009. The justificatory power of moral experience. Journal of Medical Ethics 35 (4):234–37. doi: 10.1136/jme.2008.026559. Widdershoven, G., T. Abma, and B. Molewijk. 2009. Empirical ethics as dialogical practice. Bioethics 23 (4): 236–48. doi:10.1111/j.1467-8519.2009.01712.x.","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"51-53"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490768","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 Place of Bioethics in Philosophy: Toward a Mutually Constructive Integration.","authors":"Wayne Shelton, Daniel T Kim, Pierce Randall","doi":"10.1080/15265161.2022.2134491","DOIUrl":"https://doi.org/10.1080/15265161.2022.2134491","url":null,"abstract":"The critique to which Blumenthal-Barby et al. (2022), respond—that philosophy has little left to do in bioethics—reflects a common assumption that normative theorizing first generates general moral principles that are then applied to particular cases. On this view, moral philosophy is often assumed to be an ahistorical intellectual activity (AHIA) sufficient for generating principles and foundational arguments that will determine how we understand human morality and make moral progress. Once the philosophical foundations are laid, so the assumption goes, the philosophical work ends, and the practical work begins. However, it is striking that much of the target article’s response to the skeptics appears to be framed in a manner consistent with the assumption that philosophy is an AHIA. The many examples the authors use to argue for the role of philosophy in bioethics focus on philosophy’s one-way contributions to bioethics. But this tendency persists also in their discussions about integrating and connecting the two fields. Their suggestions focus on the application and translation of “general principles, concepts, and theories” and “technical concepts from metaphysics and epistemology” (1). Although the authors note that a philosopher’s work in bioethics can enrich their philosophical work (13), little is made of this point. Though we agree with the authors that descriptive ethics should not be conflated with normative ethics (1), it does not follow that sources of ethical judgment reside entirely in the domain of philosophical ethics as they risk implying. In this OPC, we will show that philosophy’s entry into medicine in the 1960s and ’70s, was the beginning of a dialectical process that has allowed philosophy to reconstitute itself, as an evolving reflective activity in applied problematic situations. We conclude that appreciating this dialectic is critical to the possibility of a mutually constructive integration of philosophy and bioethics. In our view, philosophical ethical theorizing, understood as an AHIA, should not be assumed to be a sufficient starting point for normative ethics in an applied field such as bioethics. Such an assumption can, on the one hand, overstate the self-sufficiency of philosophical arguments and, on the other, understate the interdisciplinary nature of bioethics as a field. In response to skepticism about philosophy’s impact on bioethics, the authors claim that it was arguments, not data, that “birthed the field of bioethics and moved the field forward ... and changed the way medicine was practiced and how people behaved” (9). This claim belies the historical roots of modern bioethics in revelations about the many abuses in human subjects research, both in Nazi Germany and in the United States, that eventually had a profound impact on medicine (Jonsen 2003). For example, from 1960–79, the practice habits of oncologists went from very often withholding the diagnosis of cancer from patients to almost always disclos","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"54-56"},"PeriodicalIF":13.4,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40490767","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":"OrganEx: What Will It Mean?","authors":"Henry T Greely","doi":"10.1080/15265161.2022.2129235","DOIUrl":"https://doi.org/10.1080/15265161.2022.2129235","url":null,"abstract":"In April 2019 Yale Professor Nenad Sestan’s “BrainEx” experiments startled the world (Vrselja 2019). Four hours after pigs were decapitated, researchers perfused the pigs’ brains using what they called “BrainEx,” a machine that circulated a fluid made up mainly of a synthetic hemoglobin. Astoundingly, many of the cells in the pig brains “came back to life” even though conventional wisdom had been that brain cells die, irrevocably, after about ten minutes without oxygen. The researchers found no signs of organized neuronal firings, no pattern on an electroencephalogram (“EEG”), and concluded “This is not a living brain, but it is a cellularly active brain...” (Thompson 2019). BrainEx was a sensation but Sestan’s team has published nothing more about it and, after a few commentaries (Farahany, Greely, and Giattino 2019; Youngner and Hyun 2019), it quietly receded. In early August 2022, though, Sestan’s team caused another big gasp with the publication of the results of its experiments with “OrganEx”, using a similar device and fluid to BrainEx, but for the entire body, not just the brain (Andrijevic et al. 2022). In this experiment, pigs were anesthetized and then killed with induced cardiac arrest. After about an hour near body temperature, the dead pigs’ blood vessels were filled with a perfusate similar to BrainEx’s. And, like BrainEx, OrganEx worked, at least somewhat, attracting media attention and raising hopes, fears, and issues.","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"4-7"},"PeriodicalIF":13.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40466471","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":"Optimizing Decision-Making in the Gray Zone at Birth.","authors":"A A E Eduard Verhagen","doi":"10.1080/15265161.2022.2132317","DOIUrl":"https://doi.org/10.1080/15265161.2022.2132317","url":null,"abstract":"A provocative Target Article in this issue of AJOB proposes a new approach to decision-making for babies born in the “gray-zone” at the margins of viability. Titled “Postponed Withholding: balanced decision-making at the margins of viability,” (Syltern et al. 2022) it addresses a well-known problem in neonatal bioethics. Doctors and parents often agonize about what to do since treatment is neither clearly futile nor clearly beneficial and a decision about providing or foregoing life-prolonging treatments must instantly be made (Janvier et al. 2017). In this “gray zone,” many options are legal, reasonable people disagree about the right thing to do, and a decision must be made. The proposed approach may not be the ultimate solution to these dilemmas but, for reasons that I will show, it should help us think about what is at stake in different approaches to these complicated decisions. Janicke Syltern et al. start by explaining why these decisions are medically, ethically and emotionally so complex. They argue that, given this complexity, the parents are the legitimate owners of decisions in the gray zone and shared decision-making (SDM) is the appropriate process. In practice, however, the emotional stress and ethical complexity can inhibit a truly shared process of decision-making. As these authors note, parents are often overwhelmed by the invitation to participate and the need to make a rapid decision. This is why they propose a 3-part strategy to improve the process by which physicians work with parents to make these decisions. The aim of this strategy is to give the parents enough time to become competent, empowered decision-makers and promote SDM. The proposed strategy is that: (1) life-sustaining treatment should be started as a default for all extremely preterm infants in the gray zone; (2) this should be labeled a non-decision and considered as only a temporizing delay in decision making; (3) a planned decision about further intensive care should be made at one week; At that point, the default action should be to redirect to compassionate care and cease life-prolonging measures for infants who still fall in the gray-zone unless parents explicitly ask for continued life-support. The authors refer to this as “the postponed withholding approach” (PPWH) because it allows the parents to opt for intensive care, or not, after a week. The approach tries to capitalize on the phenomenon that, for many people, withholding treatment feels preferable to withdrawal of treatment. PPWP is presented as a practical and well-considered way of dealing with two problematic realities at the bedside that are familiar for all healthcare providers and parents involved in NICU-care. First, for babies in the gray zone, it is impossible to know each baby’s outcome and so it is uncertain whether resuscitation or comfort care is the best choice. Second, although SDM is preferred, the unexpected nature of preterm birth and the need for an immediate decision make it oft","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"1-3"},"PeriodicalIF":13.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40466474","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":"Is It Ethical to Mandate SARS-CoV-2 Vaccinations among Incarcerated Persons?","authors":"Lao-Tzu Allan-Blitz","doi":"10.1080/15265161.2021.1974978","DOIUrl":"https://doi.org/10.1080/15265161.2021.1974978","url":null,"abstract":"Incarcerated persons have suffered a disproportionate burden of SARS-CoV-2 infection compared to the general population (Saloner et al. 2020; Otugo and Wages 2020), with heightened risk for adverse outcomes due to higher proportion of comorbidities among that population (Dumont et al. 2012). A recent report from the Centers for Disease Control and Prevention (2021), however, estimated that only 45% of incarcerated persons would be willing to receive one of the three effective vaccines (Stern et al. 2021). I argue that, in this case, statemandated SARS-CoV-2 vaccination among incarcerated persons is ethically permissible. I will show that incarcerated persons may constitute a core group of individuals with the potential to sustain the transmission of SARSCoV-2 in the general population, that the imposition, by the state, of SARS-CoV-2 vaccination would reduce SARS-CoV-2 infection, and thus SARS-CoV-2 deaths, among incarcerated populations and the general population, and finally, that applying the theory of act utilitarianism, state-mandated SARS-CoV-2 vaccination is ethical and would maximize the overall utility of the population. Importantly, however, the uptake of SARS-CoV-2 vaccination has been heterogeneous, with some prisons reporting over 70% vaccination rates among incarcerated persons (California Department of Corrections and Rehabilitation 2021). For our purposes, the discussion of vaccine-mandates and the ethical considerations therein will be limited to the subset of institutions with vaccination below the 50th percentile and turnover of incarcerated persons above the 75th percentile (defined as the number of releases divided by the number of entries plus the average prison population of the previous year (Baggio et al. 2019), decided in relation to cutoffs for herd immunity (discussed below) and as a mechanism to define the most high-risk institutions. Institutions with higher vaccine coverage may still warrant the focus of educational campaigns and incentivization in order to continue to improve vaccine coverage. Further, in order to minimize infringement on individual rights, I consider it advisable that independent review boards be established to oversee any efforts made towards vaccine mandates, ensuring sufficient explanation and justification be provided to subjected individuals, as well as to iteratively evaluate the ethical and biological factors that constitute our original justification to facilitate termination of the campaign at the earliest possible date. To begin, four important factors of the dynamics of SARS-CoV-2 transmission within the prison system are important to highlight. First, there is a high prevalence of SARS-CoV-2 infection among incarcerated individuals (Saloner et al. 2020; Otugo and Wages 2020). Second, risk for SARS-CoV-2 acquisition is compounded by overcrowding (Baggio et al. 2019), contributing to viral transmission (Cerami et al. 2021). Third, the population of incarcerated individuals is not static,","PeriodicalId":145777,"journal":{"name":"The American journal of bioethics : AJOB","volume":" ","pages":"8-10"},"PeriodicalIF":13.4,"publicationDate":"2022-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39477288","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}