bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Utility of Basic Animal Research
Authors: Carbone Larry 
Published: October 2014

AbstractFor animal research that causes sentient nonhuman animal suffering to be justifiable, I believe that two conditions must be met. First, harming animals for human benefit must be morally justified; this is the speciesism justification. Second, animal research must have utility—that is, it must produce useful, empirically valid knowledge that successfully increases our understanding of human illness and treatments and that could not reasonably be obtained through other means; this is the utility justification. In other words, (some) animals must be sufficiently different from humans in morally relevant ways to allow the morality of speciesism, and (some) animals must be sufficiently similar to humans biologically for cross‐species extrapolation to have utility. Both conditions are necessary, and neither by itself is sufficient to justify animal experimentation.I focus exclusively on the utility justification. I do not defend the morality of using animals in experiments, nor do I review the alternatives and refinements that can minimize laboratory animal suffering. I will argue that I and the medical scientists with whom I work have a sound rationale to continue the work we do.
No Animals Harmed: Toward a Paradigm Shift in Toxicity Testing
Authors: Zurlo Joanne 
Published: October 2014

AbstractAdvances in science have led to a new vision for toxicity testing based on human cell systems that will be more predictive, have higher throughput, cost less money, and be more comparable to real‐life exposures in humans, while using many fewer animals. This vision, embraced by leading scientific and regulatory groups, is a paradigm shift from animal‐based to human‐based testing that signals a major change in focus and promotes the development of new approaches to understanding the toxicity of chemicals in humans. Information gained from these new approaches will likely affect other areas of research as well, leading to less reliance on animals in the future.
Alzheimer's disease and personhood
Authors: Parens Erik 
Published: October 2014

AbstractAs in the United States, the Dutch conversation about assisted suicide emerged primarily in the context of cancer. At least in that context, before acceding to a request for assistance in dying, caregivers must be sure that the person has made a voluntary and carefully considered request, and that her suffering is unbearable and without prospect of improvement. The Dutch have recently been trying to use those criteria in the context of Alzheimer's disease. Given the wave of Alzheimer's cases poised to crash onto wealthy countries, along with emerging technology to detect the disease process before symptoms appear, we should be grateful to the Dutch for that attempt.As a newcomer to this discussion, however, I was struck that those criteria may have a somewhat odd result. A patient with Alzheimer's disease can easily meet the conditions in the early stage of the disease, when one usually has the mental capacity to request assistance in dying and to make the case that one's existential suffering is unbearable. If one is in the late stage, though, it can be much harder to get such assistance because one does not have that capacity.
New Report Features
Authors: Kaebnick Gregory E. 
Published: October 2014

AbstractWe introduce several new editorial developments in this issue aimed at increasing the conversational give‐and‐take that appears in our pages. First, we are moving our editorial, Another Voice, to a spot following the article it addresses, which allows us to experiment with it a bit, letting it run longer and soliciting multiple editorials–“Other Voices.” Second, our letters section has been rebranded “Exchange” to acknowledge the short essay section that, over the years, it has grown to be. And finally, this issue includes, as a supplement, a guest‐edited Special Report that takes up the idea of a “learning health care system.” It is our hope and plan that this will be the first in an occasional series of externally sponsored Special Reports, and we welcome proposals for additional installments in the series.
The Importance of Rationality
Authors: Schaefer G. Owen 
Published: October 2014

AbstractOne of three commentaries on “Scholarly Discussion of Infanticide?” by Mirko D. Garasic, and “Reflections from a Troubled Stream: Giubilini and Minerva on ‘After‐Birth Abortion,’” by Michael Hauskeller, from the July‐August 2012 issue.
The Authors Reply
Authors: Hauskeller Michael 
Published: October 2014

AbstractA reply by the author of “Reflections from a Troubled Stream: Giubilini and Minerva on ‘After‐Birth Abortion’” to “The Arguments Matter,” by Don Marquis, “The Importance of Rationality,” by G. Owen Schaeffer, and “Reasons and Freedom,” by Alberto Giubilini and Francesca Minerva.
The Outlier
Authors: Kirschner Kristi L. 
Published: October 2014

AbstractAmy's excellent home care was the only reason she was doing as well as she was. There was no one better at taking care of Amy than her husband. When she had a respiratory infection, Steve managed the necessary increased suctioning, nebulizer treatments, and ventilator, in addition to all the other intimate personal assistance she needed on a routine basis. Yet by law he could not be paid to be her personal care assistant. After a revolving door of unreliable, inadequate assistants and recurring medical crises, Amy and Steve made the painful decision to divorce so he could quit his job and be paid by the state to care for her.
Not with a Bang, but a Whimper: Sherley v. Sebelius
Authors: Davis Dena S. 
Published: October 2014

AbstractAfter a tortuous legal process that resembled nothing so much as a game of chutes and ladders, on August 24, 2012, the United States Court of Appeals for the District of Columbia Circuit decided in favor of the Department of Health and Human Services' position that human embryonic stem cell research is not research that harms embryos, and therefore is not a violation of the Dickey‐Wicker Amendment. Bioethicists have been following this case because of our interest in the ethics and politics of embryonic stem cell research, but the final decision hinged largely on a series of rather arcane points of law and procedure.
Determining Death in Uncontrolled DCDD Organ Donors
Authors: Bernat James L. 
Published: October 2014

AbstractThe most controversial issue in organ donation after the circulatory determination of death is whether the donor was truly dead at the moment death is declared. My colleagues and I further analyzed this issue by showing the relevance of the distinction between the “permanent” and the “irreversible” loss of circulatory functions. Permanent cessation means that circulatory function will not return because it will not be restored spontaneously and medical attempts to restore it will not be conducted. By contrast, irreversible cessation means that circulatory function cannot be restored using currently available technology. In this issue of the Report, Kevin Munjal and colleagues criticize the unjustified application of the permanent‐irreversible distinction, which my colleagues and I developed for cDCDD, to their well‐designed and carefully conducted experimental protocol of uncontrolled DCDD (uDCDD) in New York City, for which our analysis was not targeted. They claimed that to determine a donor's death in uDCDD, it is unnecessary to show that permanence is a valid surrogate indicator of irreversibility because the unsuccessful attempt to resuscitate the patient comprises prima facie evidence of circulatory irreversibility. Ironically, that potent justification defending death determination in uDCDD yields limitations that are similar to those created when our permanent‐irreversible distinction is applied to death determination in cDCDD.
Reasonable Disagreement about Identifed vs. Statistical Victims
Authors: DANIELS NORMAN 
Published: October 2014

AbstractPeople tend to contribute more—and think they have stronger obligations to contribute more—to rescuing an identified victim rather than a statistical one. Indeed, they are often disposed to contribute more to rescuing a single identified victim than a greater number of statistical ones. By an “identified victim,” I mean Terry Q., lying injured in the passenger seat of the wrecked automobile on the corner of Main Street and Broadway, or Jessica McClure, the child who fell into the Texas well in 1987 and whose family was sent $700,000 in donations for her. We need not know their names, however, and we can accept a very minimal form of identification. By a “statistical victim,” I mean the person who, extrapolating from traffic records, will be in a similar, serious car accident tomorrow (and may then be identified), or the children who will fall into wells next year if we do not cap them better than we did the well that trapped Jessica.Does this disposition (or perceived obligation) have any normative force? I initially thought there could be no such normative force, but consequentialist and nonconsequentialist arguments, pro and con, have convinced me that reasonable people can disagree with each other. This disagreement poses a problem for political philosophy: how should policy choices take such disagreement into account?
Ethical Oversight: Serving the Best Interests of Patients
Authors: Selby Joe V. , Krumholz Harlan M. 
Published: October 2014

AbstractThe papers by Nancy Kass, Ruth Faden, and colleagues describe an ethical imperative to study clinical care as it is being delivered. The goal of learning from each patient is attractive, but integrating research and clinical practice is not easy. The authors suggest that the bioethical framework in use for the past forty years to oversee clinical research may be as much an impediment to the development of a learning health care system as a means of protecting the interests of patients. This framework draws a bright line between clinical research and clinical care activities, subjecting clinical research to institutional review and ongoing oversight while assuming that clinical care is conducted primarily in the interests of patients and not in need of additional ethical oversight. The authors identify five characteristics that have been used to distinguish the two activities, and they conclude that none succeed. The practical implications of this conclusion are left unspecified, however. Should ethical oversight simply be eliminated for these kinds of research activities on the grounds that oversight is not mandated for clinical care and the two cannot be distinguished?
The Perils of Progress
Authors: MEILAENDER GILBERT 
Published: October 2014

AbstractIn Contested Reproduction, John Evans outlines the results of a major piece of sociological research he has conducted. Evans suspects that reproductive genetic technologies will be a significant issue in coming cultural conflicts in the United States and that religious perspectives will play an important role in determining the shape these conflicts take. If one believes that we are hopelessly and bitterly divided on such issues, then the shape of our future conflicts may simply pit one entrenched side against another. Evans’ findings suggest that ordinary religious believers in the United States have rather complex views about these technologies—more shades of gray than black or white. He concludes that the coming conflicts may be neither as insuperable nor as hopeless as we sometimes suppose. Serious exchange, and not just caricature or dismissal, may characterize even our deep disagreements.Perhaps so. But a reading of Progress in Bioethics, a collection of essays edited by Jonathan D. Moreno and Sam Berger, might give one pause here, and not because of anything it reveals about the views of religious believers.
Manipulation in the Enrollment of Research Participants
Authors: Mandava Amulya , Millum Joseph 
Published: October 2014

AbstractRecruitment is a challenge for many biomedical research studies with human participants. Strategies to increase the speed and ease of recruitment are therefore valuable. One way to improve these strategies is to design them so as to make use of other factors that play a role in potential participants’ decisions. In this paper, we analyze the noncoercive ways in which researchers can use knowledge about the decision‐making tendencies of potential participants in order to motivate them to consent to research enrollment. We identify which modes of influence preserve respect for participants’ autonomy and which disrespect autonomy, applying the umbrella term “manipulation” to the latter. We then apply our analysis to a series of cases adapted from the experiences of clinical researchers in order to develop a framework for thinking through the ethics of manipulating people into research participation. All manipulation disrespects autonomy and is therefore pro tanto wrong. However, only deceptive manipulation invalidates the consent that results from it. Use of the other forms of manipulation can be permissible, but only if the outcome of using manipulation is sufficiently good, and the research cannot be carried out using ethically preferable means to obtain consent.
The Author Replies
Authors: Johnston Josephine 
Published: October 2014

AbstractA reply by the author of “Normalizing Atypical Genitalia: How a Heated Debate Went Astray,” to “The Battle Lines of Sexual Politics and Medical Morality,” by John D. Lantos, and “More Rhetoric Than Argument?” by Ellen K. Feder, Alice Dreger, and Anne Tamar‐Mattis.
Drug Compounding, Drug Safety, and the First Amendment
Authors: Dresser Rebecca 
Published: October 2014

AbstractIn September 2012, news broke of a developing drug disaster in the United States. Health authorities had linked a fungal meningitis outbreak to a contaminated steroid made by a company called the New England Compounding Center. The contaminated steroid was a compounded drug that had not been approved by the Food and Drug Administration, differing from three others that had been approved in that it lacked preservatives present in those agents. Factory inspections revealed unsanitary conditions at NECC's drug production facility. By the time the source of the outbreak was identified, an estimated fourteen thousand people had been injected with the drug. As of December 2012, thirty‐nine had died of meningitis, and hundreds more had been diagnosed with meningitis and other drug‐related conditions.Many factors contributed to this disaster. One was a 2002 Supreme Court decision holding that a law prohibiting providers of compounded drugs from promoting their products through advertising and other means impermissibly restricted commercial speech.
What's So Meaningful about Meaningful Use?
Authors: Galbraith Kyle L. 
Published: October 2014

AbstractThe 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act aims to promote the use of electronic health records by providing over $27 billion in financial incentives for eligible health care providers who become “meaningful users” of them. The goal of increased “meaningful” electronic health record adoption is to create a more efficient, patient‐centered health care system by lowering providers’ administrative costs, improving coordination of care among multiple providers, and increasing patients’ participation in and responsibility for their own care. Recently published data from the Centers for Disease Control and Prevention's National Center for Health Statistics indicate that the HITECH Act's passage has led to a significant increase in electronic health record use among physicians. However, everyone involved in the conversations surrounding the HITECH Act—health care analysts, policy‐makers, and providers alike—must recognize that “meaningful use” of electronic health records can only be authentically meaningful to both clinicians and patients when certain structural issues are also addressed.
Found Your DNA on the Web: Reconciling Privacy and Progress
Authors: Gutmann Amy , Wagner James W. 
Published: October 2014

AbstractAn article by Melissa Gymrek and colleagues, published this January in Science, described how the researchers used surname inferences from commercial genealogy databases and Internet searches to deduce the identity of nearly fifty research participants whose supposedly private data were stored in large, publicly available datasets. This news comes just months after the Presidential Commission for the Study of Bioethical Issues published a report that expressed serious concerns about personal privacy and security in whole genome sequencing. The bioethics commission (on which we serve as chair and vice‐chair) highlighted the importance of reconciling the enormous public benefits anticipated from research in this area with the potential risks to individuals’ privacy, and it offered several policy proposals to help balance the potential of scientific progress with privacy and respect for persons.The human subjects research protections laid out in the federal regulations are triggered by the identifiability of data. The participants in the Gymrek et al. study were not “readily identifiable”; however, the data proved far more easily identifiable than expected. With rapidly evolving technology, a precise definition of that notion may be impossible. But if we move the debate from the rhetoric of identifiability to the ethical principles of public beneficence and the centrality of respecting all persons, we find that the real ethical focus must be on promoting generalizable progress while at all times respecting individual privacy.
Continuing education
Authors: Griffin Joyce A. 
Published: October 2014

AbstractWorking at The Hastings Center has been a tremendous professional stepping stone for me. I have long wanted to work in publishing, and I'm leaving the Center to work for America's oldest publisher, John Wiley and Sons. But I feel that my time here has been more than that‐that it has truly continued my education in ways I could not have anticipated. Thank you for letting me be part of your intellectual lives.
The Predictable Irrationality of Righteous Minds, and the Work of Ethicists
Authors: Ubel Peter A. 
Published: October 2014

AbstractAs Jonathan Haidt explains in The Righteous Mind, it is often our moral intuitions that come first, rapidly or even automatically, with ethical reasoning coming later. Haidt's book is one of many that have come out in recent years highlighting the relevance of psychology (and its close cousin, neuroscience) for understanding human morality. As a behavioral scientist, I have devoured many of these books. I am fascinated by human nature and love trying to understand why all of us behave and think the way we do. But as a physician ethicist, I often find myself reading these books with a parallel agenda: not just to understand human nature, but also to see whether this line of research has relevance for my work as an ethicist. My bottom line: Understanding moral psychology ought to be a required component of ethics training, not because the science will help us to differentiate between right and wrong, but because it will better equip us to teach ethics in a way that promotes moral behavior in our students.
Shots for Tots?
Authors: Feldman Eric A. 
Published: October 2014

AbstractBy endorsing the use of a vaccine that makes the experience of puffing on a cigarette deeply distasteful, Lieber and Millum have taken the first few tentative steps into a future filled with medical interventions that manipulate individual preferences. It is tempting to embrace the careful arguments of “Preventing Sin” and celebrate the possibility that the profound individual and social costs of smoking will finally be tamed. Yet there is something unsettling about the possibility that parental discretion may be on the cusp of a radical expansion, one that involves a new and unexplored approach to behavior modification.
What's Not Being Shared in Shared Decision‐Making?
Authors: Stark Meredith , Fins Joseph J. 
Published: October 2014

AbstractWhat's not to like about shared decision‐making? These programs employ specially crafted decision aids to educate patients about their treatment options and then merge the newly informed patient preferences, both general and treatment‐specific, with guidance from physicians to optimize medical decisions. Sounds great, right? Even better, recent evidence indicates that shared decision‐making programs may also help bend the proverbial cost curve by reducing the use of medical interventions that patients, now properly educated about their options, often say they do not want. The notion that programs to inform and elicit patient choice might also help to align health care delivery with patient preferences for less invasive and therefore less costly treatment options seems the rarest of mutual wins in health care, in which what is best for the individual might also benefit the whole. Yet there has been scant attention to how the goals of patient care and cost‐containment, and perhaps even profitability, coincide or conflict.
Fairness, health, and access
Authors: Gusmano Michael 
Published: October 2014

AbstractDuring the past two years, much of my work at The Hastings Center has explored the implementation of health reform in the United States and its implications for poor and vulnerable groups. These projects include a study of access to care for undocumented patients and one that examines state‐level decisions about health reform, including Medicaid expansion and the creation of health insurance “marketplaces.” Both raise issues central to bioethics, including fairness, justice, and the stewardship of society's resources. Our nation spent about 2.7 trillion dollars on health care in 2012, and its major public health insurance programs represent over 20 percent of the federal budget. Despite these investments, there are troubling differences in life expectancy, infant mortality, and premature death depending on factors like income, race, ethnicity, gender, and where people live.
The Death Debates: A Call for Public Deliberation
Authors: Rodríguez‐Arias David , Véliz Carissa 
Published: October 2014

AbstractIn this issue of the Report, James L. Bernat proposes an innovative and sophisticated distinction to justify the introduction of permanent cessation as a valid substitute standard for irreversible cessation in death determination. He differentiates two approaches to conceptualizing and determining death: the biological concept and the prevailing medical practice standard. While irreversibility is required by the biological concept, the weaker criterion of permanence, he claims, has always sufficed in the accepted standard medical practice to declare death. Bernat argues that the medical practice standard may be acceptable on the ground that proving circulatory or brain permanence is sufficient to assure complete accuracy for death diagnosis.The topic requires public deliberation: processes to survey people's opinions and mechanisms to channel their opinions into policy‐making. What is at stake is the nature of our society. Do we want an expertocracy, in which an enlightened few design policies for the greater good of the majority and exploit the lack of public knowledge to achieve compliance?
The Quest for Justice in Global Health
Authors: Benatar Solomon 
Published: October 2014

AbstractA number of high‐profile ethical dilemmas are embedded in the emerging topic of global health. The three books under review here provide various lenses through which to view them. In Ethics in Global Health: Research, Policy, and Practice, Ruth Macklin offers finely honed contemporary arguments and applies them to the future. Global Justice and Bioethics, a collection of essays edited by Joseph Millum and Ezekiel Emanuel, focuses on theories of justice, and in Long‐term Care, Globalization and Justice, Lisa Eckenwiler looks more broadly at the global implications of caring for the aged in wealthy societies.