Hastings Center Research Articles

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About The Hastings Center

The Pandemic: Lessons for Bioethics?

Seeking useful ways to respond to the Covid‐19 pandemic, bioethicists have been tempted to claim for themselves what Alasdair MacIntyre characterized in After Virtue as the moral fiction of managerial expertise. They have been eager to offer a wide range of policy prescriptions, presenting themselves as bureaucratic managers and suggesting an expertise that bioethics may not in fact be able to offer. This was evident, for example, in the petition published by The Hastings Center in March 2020. The pandemic could foster a more hopeful future for bioethics if it were to focus attention less on policy decisions that belong to all citizens and more on some of the most basic moral questions that life presents and with which bioethics has always dealt—including, surely, the virtues needed in order to live well in a time of pandemic.

Learning from a Pandemic.

The Covid‐19 pandemic has highlighted connections between health and social structural phenomena that have long been recognized in bioethics but have never really been front and center—not just access to health care, but fundamental conditions of living that affect public health, from income inequality to political and environmental conditions. In March, as the pandemic spread globally, the field's traditional focus on health care and health policy, medical research, and biotechnology no longer seemed enough. The adequacy of bioethics seemed even less certain after the killing of George Floyd, whose homicide showed in an especially agonizing way how social institutions are in effect (and often intentionally) designed to make the lives of black people go poorly and end early. Whether bioethics needs to be expanded, redirected, and even reconceived is at the heart of the May‐June 2020 issue of the Hastings Center Report, which is devoted to questions provoked by and lessons emerging during this pandemic.

All People.

In early March 2020, the March-April Hastings Center Report was very nearly assembled and contained nothing about Covid-19, which was still just beginning to make itself publicly known in the United States. Two weeks later, the editorial line-up was undergoing a remix, and essays that lay out sweeping agendas for the response to the worldwide crisis were in preparation. The central theme in the agenda that Lawrence O. Gostin and colleagues develop is that the pandemic requires a sharp break from usual ethical norms yet simultaneously demands a return to core ethical commitments. A similar theme is sounded by Mildred Z. Solomon and colleagues in a commentary calling for federal actions to keep the health care system functioning. Other essays in the issue take up an assortment of topical issues-including international patient dumping-that were simmering along prior to the pandemic, and the two articles take up foundational questions about the nature of moral reasoning.

Contributors

Hastings Center ReportVolume 50, Issue 2 p. 48-48 Contributors Contributors First published: 20 April 2020 https://doi.org/10.1002/hast.1106Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume50, Issue2March/April 2020Pages 48-48 RelatedInformation

Chinese Bioethicists Speak Out on Covid‐19, and Others Follow

Shortly after Wuhan, the city where the novel coronavirus was first identified, was placed on lockdown in January, I received an email from two Hastings Center fellows in China: Renzong Qiu, of Renmin University of China in Beijing, and Ruipeng Lei, of Huazhong University of Science and Technology in Wuhan. Attached was a post for our blog, Hastings Bioethics Forum, that raised ethical and legal questions about China's response. “Hegel says, ‘We learn from history that we do not learn from history,’” their piece began. “The recurrence of the coronavirus epidemic in China proves his insight to be right.” This bold report from bioethicists in China was courageous and eye‐opening. It was among the first discussions in bioethics of what has since become a global crisis, and it turned out to be the first in a string of commentaries in Hastings Bioethics Forum with insights about the crisis, the issues it raises, and how the world should respond to it.

Physician Burnout and the Americans with Disabilities Act

The writer responds to the commentary "Physician Burnout Calls for Legal Intervention," by Sharona Hoffman, in the November-December 2019 issue of the Hastings Center Report.

Sharona Hoffman Replies.

Hastings Center ReportVolume 50, Issue 2 p. 47-47 letter Sharona Hoffman Replies Sharona Hoffman, Search for more papers by this author Sharona Hoffman, Search for more papers by this author First published: 20 April 2020 https://doi.org/10.1002/hast.1105Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume50, Issue2March/April 2020Pages 47-47 RelatedInformation

Kevin Mintz and David Wasserman Reply

Hastings Center ReportVolume 50, Issue 2 p. 46-47 letter Kevin Mintz and David Wasserman Reply Kevin Mintz, Search for more papers by this authorDavid Wasserman, Search for more papers by this author Kevin Mintz, Search for more papers by this authorDavid Wasserman, Search for more papers by this author First published: 20 April 2020 https://doi.org/10.1002/hast.1103Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume50, Issue2March/April 2020Pages 46-47 RelatedInformation

Pediatric Drug Labeling and Imperfect Information.

I first became aware of bioethics in the spring of 1980. I had spent a thirty-six-hour shift shadowing a medical resident, and I was struck that many of the resident's decisions had ethical dimensions. The next day, I came across the Hastings Center Report, and I realized I wanted to explore ethical issues I found implicit in clinical care, even though I still wanted to become a pediatrician. In September 2019, when I attended my first meeting of the U.S. Food and Drug Administration's Pediatric Advisory Committee, as a pediatric pulmonologist, I had the same sense of awe and curiosity that I had forty years ago. What had appeared initially as somewhat technical decisions about the regulation of drug labeling was suffused with ethical questions. The committee was asked to discuss possible changes to the labeling of two previously approved drugs.

Chimeras and the Problem of Other Minds.

The writer responds to the article "Human-Animal Chimeras: The Moral Insignificance of Uniquely Human Capacities," by Julian J. Koplin, in the September-October 2019 issue of the Hastings Center Report.

Storytelling

The November-December issue of the Hastings Center Report features a set of essays on the ethics of writing stories of patient care. The Report regularly features such stories, but some ways of telling them would be plainly unacceptable, and some in bioethics have suggested that the bar for acceptability is very high. Tod Chambers takes that position in this essay set. Drawing on the work of the literary theorist Mikhail Bakhtin, he proposes that case studies should be "polyphonic"-meaning that they contain "a diversity of voices that are unmediated and distinct." In effect, he calls for a kind of coauthoring of stories about patients. In a second essay, Arthur Frank also calls for including the patient's voice, but he builds on Bakhtin's call for "dialogic" storytelling, in which the author seeks to represent the characters in the story as having their own voices and their own lives: "they can talk back." A third essay, by Philip Rosoff, is concerned about the problem of harm and patient anonymity, which in the contemporary media environment has become harder to address.

Contributors

Hastings Center ReportVolume 49, Issue 6 p. 44-44 Contributors Contributors First published: 08 December 2019 https://doi.org/10.1002/hast.1071Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume49, Issue6November/December 2019Pages 44-44 RelatedInformation

Crossing Boundaries.

I met Dan Callahan in 1986-when I came to pitch him. Coming from a sleek office setting near Boston, I was intrigued by The Hastings Center's higgledy-piggledy environment where so many smart people got to work in a relaxed, inviting atmosphere. I had noticed that the Center was producing a great deal of policy work on a wide range of topics but didn't seem to go further than publishing the highly valuable guidance developed under Dan Callahan's leadership. I ended my pitch, "Look, Dan, where Hastings gets bored and wants to go on to the next topic, my group in Boston gets interested." To my great pleasure, and despite his skepticism, Dan accepted the pitch. Beyond his generous responsiveness to unproven young people, Dan had many other virtues. For one, he was a boundary crosser.

A Champion for the Unestablished.

As a student in bioethics, I knew that The Hastings Center and its founders were the height of excellence in this field, and therefore I found them both intimidating and intriguing. When I began working there, Dan Callahan was supportive of my endeavors to provide a venue for students and other young writers to express their views on bioethics. I started my own blog called Bioethx under 25 that featured short essays by anyone who wished to submit, generally individuals who had a genuine philosophical interest but were not yet at the level of pursuing a Ph.D. Dan's support of my project culminated in his sponsorship of the Daniel Callahan Young Writer's Prize, an essay contest run through the blog. This was one of the many ways he demonstrated that making theoretical contributions to bioethics should not be limited to a select few.

Contributors

Hastings Center ReportVolume 49, Issue 5 p. 48-48 Contributors Contributors First published: 03 October 2019 https://doi.org/10.1002/hast.1056Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume49, Issue5September/October 2019Pages 48-48 RelatedInformation

Healing Relationships.

In a 2015 Hastings Center Report essay, Robert Truog and his coauthors argued that the clinical ethics portion of medical education should cast both a wider and a finer net than is sometimes realized. Many of the morally important moments in patient care are missed if we teach only general moral principles, they held; we also need to give attention to an indefinite stream of "microethical" decisions in everyday clinical practice. In the current issue, Truog plays out a similar theme as he discusses the moral significance of touching a patient and asks how artificial intelligence and other emerging technologies may change this ancient part of the physician-patient relationship. And one of the articles in this issue examines the significance of clinicians' relationships with other clinicians. Donna Chen and colleagues propose, in effect, that "teamwork" has become part of the ethics of everyday clinical practice-a new addition to what Larry Churchill and David Schenck called the "healing skills."

Daniel Callahan and the Vocation of Bioethics.

Did Dan Callahan know the calling he was displaying in his own work and offering to others in the special intellectual garden of The Hastings Center, which he cocreated, with Will Gaylin, and went on to prune and tend for nearly four decades? I would say, yes, he knew what he was about. Successful people usually have self-confidence and drive in abundance, but in Dan's case, there was something more profound and interesting at work. Having gone through the endnotes of his latest book one day, I asked him how he found time to read so widely. He said he had learned to be an efficient skimmer who could pull out the nuggets he valued from another's work because he had a few magnetic ideas from which he would brook no distraction.

Daniel Callahan (1930-2019).

Daniel Callahan, cofounder of The Hastings Center, prodigious author, and pioneer in bioethics, died on July 16, 2019, three days before his eighty-ninth birthday. Callahan created The Hastings Center with Willard Gaylin in 1969. He served as its director from 1969 to 1983 and president from 1984 to 1996, and he continued as a scholar and president emeritus until his death, publishing books and essays and leading research projects. Tributes published in the days following Callahan's death celebrated him for his role in creating bioethics, for his challenging questions and unconventional thinking, and for his ability to do incisive scholarship in a way that had a public impact.

A Last Gift.

Here at the Center, we had the privilege of seeing how Dan Callahan lived out his last days and weeks. True to his nature, Dan never stopped thinking or writing. Indeed, his wife Sidney told me that he finished his last essay one day before his death, on July 16th, insisting that she help him get to the computer so he could discuss it with a colleague. "It's my last one," he told her with his characteristic self-awareness. Dan also chose the last topic he would focus on: climate change. At a December 2018 board meeting, Dan presented his desire to develop a workshop to explore the ways in which bioethics in general, and The Hastings Center in particular, might be able to make a valuable contribution to addressing the problem of global warming.