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Moral Worlds and Institutional Scripts at the End of Life 生命终结时的道德世界和制度脚本。
IF 2.7 3区 哲学
Hastings Center Report Pub Date : 2026-07-20 DOI: 10.1002/hast.70074
Patrick McCruden, Rachelle Barina
{"title":"Moral Worlds and Institutional Scripts at the End of Life","authors":"Patrick McCruden,&nbsp;Rachelle Barina","doi":"10.1002/hast.70074","DOIUrl":"10.1002/hast.70074","url":null,"abstract":"<p><i>This commentary responds to Jennifer Blumenthal-Barby and colleagues’ article, “Can I Get a Witness? The Ethical Dimensions of Family Presence in Patient Suffering.” The authors examine clinicians’ moral distress when family members are absent from the bedside of dying patients and assess moral arguments for requiring family presence. We concur with their skepticism toward any strong obligation for family members to be physically present when continued treatment is considered burdensome or futile. We extend the authors’ analysis by arguing that institutional culture shapes expectations of the “good patient,” the “good family,” and the “good death.” Drawing on sociology, anthropology, and philosophy, we suggest that clinicians’ distress may arise not only from family absence but also from tensions between institutional norms and the moral worlds families inhabit. We conclude by calling for epistemic humility and greater critical reflection on the impact of institutional norms on moral judgments</i>.</p>","PeriodicalId":55073,"journal":{"name":"Hastings Center Report","volume":"56 4","pages":"25-26"},"PeriodicalIF":2.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Beyond Words: Addressing Ethical Issues in Clinical Documentation through Medical Education 超越语言：通过医学教育解决临床文献中的伦理问题。
IF 2.7 3区 哲学
Hastings Center Report Pub Date : 2026-07-20 DOI: 10.1002/hast.70034
Danielle Wilfand, Lindsey Grubbs
{"title":"Beyond Words: Addressing Ethical Issues in Clinical Documentation through Medical Education","authors":"Danielle Wilfand,&nbsp;Lindsey Grubbs","doi":"10.1002/hast.70034","DOIUrl":"10.1002/hast.70034","url":null,"abstract":"<p><i>Stigmatizing language in medical documentation is a barrier to achieving patient-centered care and health justice: it can contribute to patient distrust and alienation, and it appears more frequently in the charts of patients from marginalized groups, especially Black patients, impacting the future care they receive. One powerful avenue to address this issue is within undergraduate medical education; however, while some have investigated educational interventions to improve accuracy and technical proficiency in charting, there is significantly less focus on instruction surrounding the ethical and social consequences of documentation. We contend that incorporating activities designed to elicit critical thinking about language, power, and structural injustice can encourage students to reflect upon and improve their documentation practices and can arm them with a critical lens through which to view the documentation generated by their peers and preceptors as they progress through training and establish the habits that will persist throughout their careers</i>.</p>","PeriodicalId":55073,"journal":{"name":"Hastings Center Report","volume":"56 4","pages":"12-18"},"PeriodicalIF":2.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hast.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mapping the Scientific Mesolevel: Where Are We Aiming? 绘制科学中观：我们的目标在哪里？
IF 2.7 3区 哲学
Hastings Center Report Pub Date : 2026-07-20 DOI: 10.1002/hast.70088
Nicholas G. Evans
{"title":"Mapping the Scientific Mesolevel: Where Are We Aiming?","authors":"Nicholas G. Evans","doi":"10.1002/hast.70088","DOIUrl":"10.1002/hast.70088","url":null,"abstract":"<p><i>Susan Wolf et al.'s article “Filling the Network Gap in Research Ethics: Analyzing Ethical Issues at Scale in Big Team Science” aims to provide analysis of ethics at the level of scientific teams. But is the emphasis on formal teams the appropriate target? In this commentary, I argue that we ought to take a much broader view, looking at the “interstitial spaces” of scientific research, including the informal networks of power and esteem that shape scientific careers, the formation and function of large teams, receipt of funding, and publication. I claim that these informal networks do as much, if not more than, formal organizing efforts in structuring scientific inquiry and norms. I conclude that an ethics of team science will be richer, more rigorous, and more effective if it treats the culture of science as a central object of study and then asks which kinds of formal organizing principles best promote and protect our ethical commitments</i>.</p>","PeriodicalId":55073,"journal":{"name":"Hastings Center Report","volume":"56 4","pages":"48-50"},"PeriodicalIF":2.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Delusion Is Not a Bug: AI, Psychiatry, and the Ethics of Uncertainty 妄想不是Bug：人工智能、精神病学和不确定性伦理。
IF 2.7 3区 哲学
Hastings Center Report Pub Date : 2026-07-20 DOI: 10.1002/hast.70045
Brent R. Carr
{"title":"Delusion Is Not a Bug: AI, Psychiatry, and the Ethics of Uncertainty","authors":"Brent R. Carr","doi":"10.1002/hast.70045","DOIUrl":"10.1002/hast.70045","url":null,"abstract":"<p><i>Recent debates about AI “guardrails” in mental health have framed a problem as one of detecting delusion. This paper argues that such framing misunderstands both psychiatry and large language models. In clinical practice, delusion is not simply a false belief but a structure of conviction that stabilizes meaning under conditions of uncertainty. Large language models, by contrast, generate coherence rather than evaluate truth. When these systems interact with users seeking orientation, they do not merely fail or succeed at detection—they participate in the conditions under which belief forms. The ethical risk is therefore not misclassification but premature coherence: the subtle reinforcement of interpretations before they can be examined. Drawing on phenomenology and clinical psychiatry, this paper proposes that safety in AI systems should be understood as the protection of provisionality—the preservation of the human capacity to remain uncertain long enough to think</i>.</p>","PeriodicalId":55073,"journal":{"name":"Hastings Center Report","volume":"56 4","pages":"7-12"},"PeriodicalIF":2.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hidden in Plain Sight: Professionalization, Accreditation, and the Legitimacy of Clinical Ethics 隐藏在显而易见的：专业化、认证和临床伦理的合法性。
IF 2.7 3区 哲学
Hastings Center Report Pub Date : 2026-07-20 DOI: 10.1002/hast.70080
D. Micah Hester, Toby Schonfeld
{"title":"Hidden in Plain Sight: Professionalization, Accreditation, and the Legitimacy of Clinical Ethics","authors":"D. Micah Hester,&nbsp;Toby Schonfeld","doi":"10.1002/hast.70080","DOIUrl":"10.1002/hast.70080","url":null,"abstract":"<p><i>A recent article by physician Ronald Dworkin, echoing research from the last five years, suggests that physicians find little value in clinical ethics consultations. At the same time, clinical ethicists have worked to create more structures and standards to ground the field's professionalization in health care. Why the disconnect? We suggest three reasons: internal professionalization work is opaque to those outside of the discipline, weak external accreditation requirements imply a lack of professionalization of ethics, and the fundamental nature of clinical ethics is distinct from other disciplines</i>.</p>","PeriodicalId":55073,"journal":{"name":"Hastings Center Report","volume":"56 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
“Where are they?” The Range and Implications of Clinician Reactions to Absent Families “他们在哪儿？”临床医生对缺失家庭反应的范围和含义。
IF 2.7 3区 哲学
Hastings Center Report Pub Date : 2026-07-20 DOI: 10.1002/hast.70093
Joshua Hauser
{"title":"“Where are they?” The Range and Implications of Clinician Reactions to Absent Families","authors":"Joshua Hauser","doi":"10.1002/hast.70093","DOIUrl":"10.1002/hast.70093","url":null,"abstract":"<p><i>In “Can I Get a Witness? The Ethical Dimensions of Family Presence in Patient Suffering,” Jennifer Blumenthal-Barby and colleagues ask us to scrutinize “the instinct to blame families” who are absent from the care of their seriously ill loved ones. In this commentary, I use a common framework of</i> differential diagnosis <i>to consider the reasons for and implications of clinician reactions to absent families. As we better understand what might be driving the absence of family members, we might also find hints at the sources of our own judgment. As with most differential diagnoses in medicine, this analysis can also help to inform how we support those families and manage our own instincts</i>.</p>","PeriodicalId":55073,"journal":{"name":"Hastings Center Report","volume":"56 4","pages":"27-28"},"PeriodicalIF":2.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Bearing Witness at the Bedside: The Role-Specific Obligations of Surrogate Decision-Makers 床边作证：替代决策者的角色特定义务。
IF 2.7 3区 哲学
Hastings Center Report Pub Date : 2026-07-20 DOI: 10.1002/hast.70083
Julia Kolak
{"title":"Bearing Witness at the Bedside: The Role-Specific Obligations of Surrogate Decision-Makers","authors":"Julia Kolak","doi":"10.1002/hast.70083","DOIUrl":"10.1002/hast.70083","url":null,"abstract":"<p><i>In “Can I Get a Witness? The Ethical Dimensions of Family Presence in Patient Suffering,” Jennifer Blumenthal-Barby and colleagues ask whether there is a duty for family members to be present at the bedside of an unconscious or minimally conscious patient. In responding to the article, I argue that the authors’ presumption against a general duty for this bedside presence follows in part from the level of generality at which the question is posed. As the categories “family,” “unconscious,” and “suffering” are too heterogeneous to generate a single, action-guiding obligation of bedside presence, I suggest that the question should be reframed as one concerning whether surrogate decision-makers should be thought of as incurring narrower role-specific obligations that sometimes require bedside presence. In surfacing the practical circumstances in which questions surrounding perceived family absence are typically raised by clinicians, this reply also suggests an overlooked dimension of such conflicts: they may signal uncertainty about the conditions under which surrogate authority is being exercised. The possibility that this uncertainty underlies clinicians’ occasional frustration can become an important conceptual foothold for clinical ethics facilitation</i>.</p>","PeriodicalId":55073,"journal":{"name":"Hastings Center Report","volume":"56 4","pages":"29-31"},"PeriodicalIF":2.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Musical Performance and Biomedical Human Enhancement: Ethnographic Perspectives on Bioethical Questions 音乐表演和生物医学人类增强：生物伦理问题的人种学观点。
IF 2.3 3区 哲学
Hastings Center Report Pub Date : 2026-05-06 DOI: 10.1002/hast.70031
Jennifer Saltzstein
{"title":"Musical Performance and Biomedical Human Enhancement: Ethnographic Perspectives on Bioethical Questions","authors":"Jennifer Saltzstein","doi":"10.1002/hast.70031","DOIUrl":"10.1002/hast.70031","url":null,"abstract":"<p><i>This article explores the use of biomedical human enhancement in the field of musical performance, focusing on the role of beta-blocking drugs, which have been used by classical musicians since the 1970s to control the symptoms of performance anxiety, primarily in high-stakes auditions. Insights gained from in-depth, structured, ethnographic interviews with professional classical musicians suggest that, unlike professional athletic communities (in which the use of beta-blocking drugs to control performance anxiety is often banned), classical musicians often view the use of beta-blocking drugs as a legitimate form of therapy or as a training tool. Although dominant bioethical frameworks for understanding human enhancement focus on values of autonomy, hard work, fairness, and justice, these values were largely absent from the way musicians conceived of beta-blocker use in their community. At a time when the use of beta-blocking drugs to control performance anxiety is spreading to job interviews, examining the impact of beta-blocker use in the field of classical music offers a real-world case study that shows how cultural values within individual communities shape ethical questions involving biomedical human enhancements</i>.</p>","PeriodicalId":55073,"journal":{"name":"Hastings Center Report","volume":"56 3","pages":"32-42"},"PeriodicalIF":2.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Rethinking Mandated Drug Treatment: Why Expanding Freedom Requires Structural Drug Policy Reform 重新思考强制性药物治疗：为什么扩大自由需要结构性药物政策改革。
IF 2.3 3区 哲学
Hastings Center Report Pub Date : 2026-05-06 DOI: 10.1002/hast.70061
Tim Holland, Tiffany O'Donnell
{"title":"Rethinking Mandated Drug Treatment: Why Expanding Freedom Requires Structural Drug Policy Reform","authors":"Tim Holland,&nbsp;Tiffany O'Donnell","doi":"10.1002/hast.70061","DOIUrl":"10.1002/hast.70061","url":null,"abstract":"<p><i>In this same, May-June 2026, issue of the</i> Hastings Center Report, <i>Brendon Saloner suggests that mandated drug treatment can expand freedom and promote egalitarian social justice so long as three criteria are met. Drawing on our clinical experience in addiction medicine and a critical appraisal of the available evidence, we challenge this claim. We argue that Saloner's three criteria are unlikely to be met within jurisdictions that criminalize drug use and lack supports for people who use drugs. The criterion that mandated treatment be “likely to be beneficial” is undermined by the coercive nature of such interventions and the lack of evidence supporting their effectiveness when compared to voluntary care. Further, the application of mandated treatment risks extending carceral oversight to individuals charged with minor offenses, disproportionately affecting equity-denied populations. Finally, we question whether infringements on liberty through legal oversight can genuinely expand freedom, particularly when such measures exacerbate social instability and undermine the potential for voluntary engagement with care. We contend that meaningful expansion of freedom for people who use drugs is better achieved through voluntary, community-based treatment models supported by robust social infrastructure. A radical reorientation of drug policy—away from coercion and toward supportive, person-centered care—is necessary to achieve the ethical aims of reducing harm, promoting autonomy, and advancing egalitarian social justice</i>.</p>","PeriodicalId":55073,"journal":{"name":"Hastings Center Report","volume":"56 3","pages":"28-29"},"PeriodicalIF":2.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Mandated Drug Treatment in the Criminal Legal System—a Blunt but Necessary Tool? 刑事司法系统中的强制药物治疗——一个钝而必要的工具？
IF 2.3 3区 哲学
Hastings Center Report Pub Date : 2026-05-06 DOI: 10.1002/hast.70038
Brendan Saloner
{"title":"Mandated Drug Treatment in the Criminal Legal System—a Blunt but Necessary Tool?","authors":"Brendan Saloner","doi":"10.1002/hast.70038","DOIUrl":"10.1002/hast.70038","url":null,"abstract":"<p><i>How should the state respond to people who commit low-level criminal offenses that stem from an untreated substance-use disorder? The issue has taken on a heightened importance amidst an ongoing national addiction crisis that has destabilized many U.S. communities and led to a myriad of harms. I offer a qualified defense for the use of legal mandates that require participation in drug treatment in lieu of jail time as one possible tool for reducing the public harms associated with chronic addiction. I argue that mandated treatment is effective, though less effective than many proponents argue. Beyond the effectiveness question, opponents contend that mandated treatment exacerbates structural inequalities, including the overpolicing of marginalized communities and underinvestment in voluntary treatment. Drawing on an egalitarian theory of justice, I argue that these structural inequalities present a compelling reason to constrain the use of mandates, but that they should be counterbalanced by a mixture of paternalistic and public safety concerns that make mandates one of several instruments in drug policy for addressing the pervasive harms from severe substance-use disorders</i>.</p>","PeriodicalId":55073,"journal":{"name":"Hastings Center Report","volume":"56 3","pages":"15-27"},"PeriodicalIF":2.3,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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