Tag: dissent

Bioethics Blogs

What can neuroethicists learn from public attitudes about moral bioenhancement?

By Peter Reiner

Dr. Reiner is Professor and co-founder of the National Core for Neuroethics at the University of British Columbia where he is a member of the Department of Psychiatry and the Centre for Brain Health. Dr. Reiner began his research career studying the cellular and molecular physiology of the brain, with particular interests in the neurobiology of behavioural states and the molecular underpinnings of neurodegenerative disease. In 1998, Dr. Reiner became President and CEO of Active Pass Pharmaceuticals, a drug discovery company that he founded to tackle the scourge of Alzheimer’s disease. Upon returning to academic life in 2004, Dr. Reiner refocused his scholarly work in the area of neuroethics, co-founding the National Core for Neuroethics with Dr. Judy Illes in 2007. Dr. Reiner has championed quantitative analysis of public attitudes towards diverse issues in neuroethics including the propriety of cognitive and moral enhancement, the contours of autonomy in the real world, and the neuroethical implications of Technologies of the Extended Mind.

Moral behavior is fundamental to human society. Wherever one goes on the planet, one finds a set of norms that guide behavior, and following these norms is a basic tenet of peaceful coexistence with one’s fellow humans. Despite abundant evidence that the arc of human history trends towards decreased violence (Pinker, 2011), a proxy for moral behavior, scholars have suggested that society might be better off were we to enhance our moral capacities, and that using biological methods to do so is warranted (Douglas, 2008; Persson and Savulescu, 2008). This has engendered a vigorous debate that goes beyond the usual divide between bioconservatives and technoprogressives (Reiner, 2013a); in this arena, even ardent proponents of enhancement technologies have registered dissent (Harris, 2010).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

End-of-Life Healthcare Sessions at ASBH 2017

The 2017 ASBH
conference
 in October 2017 includes over 400 workshops, panels, and
papers in bioethics and the health humanities.  Here are ones that pertain
to end-of-life issues.


THURSDAY, OCTOBER 19


THU 1:30 pm:  End-of-Life Care and Decision-Making in the ICU – Limited
English Proficiency as a Predictor of Disparities (Amelia Barwise)


Importance: Navigating choices in predominantly English-speaking care settings
can present practical and ethical challenges for patients with limited English
proficiency (LEP). Decision-making in the ICU is especially difficult and may
be associated with disparities in health care utilization and outcomes in critical
care. 


Objective: To determine if code status, advance directives, decisions to limit
life support, and end-of-life decision-making were different for ICU patients
with LEP compared to English-proficient patients. 


Methods: Retrospective cohort study of adult ICU patients from
5/31/2011-6/1/2014. 779 (2.8%) of our cohort of 27,523 had LEP. 


Results: When adjusted for severity of illness, age, sex, education, and
insurance status, patients with LEP were less likely to change their code
status from full code to do not resuscitate (DNR) during ICU admission (OR,
0.62; 95% CI, 0.46-0.82; p


Conclusion: Patients with LEP had significant differences and disparities in
end-of-life decision-making. Interventions to facilitate informed
decision-making for those with LEP is a crucial component of care for this
group.


THU 1:30 pm:  “But She’ll Die if You Don’t!”: Understanding and
Communicating Risks at the End of Life (Janet Malek)


Clinicians sometimes decline to offer interventions even if their refusal will
result in an earlier death for their patients. For example, a nephrologist may
decide against initiating hemodialysis despite a patient’s rising creatinine
levels if death is expected within weeks even with dialysis.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

The Specter of Authoritarianism

by Andrew J. Pierce

ABSTRACT. In this essay, I provide an analysis of the much-discussed authoritarian aspects of Donald Trump’s campaign and early administration. Drawing from both philosophical analyses of authoritarianism and recent work in social science, I focus on three elements of authoritarianism in particular: the authoritarian predispositions of Trump supporters, the scapegoating of racial minorities as a means of redirecting economic anxiety, and the administration’s strategic use of misinformation. While I offer no ultimate prediction as to whether a Trump administration will collapse into authoritarianism, I do identify key developments that would represent moves in that direction.

The unorthodox campaign and unexpected election of Donald Trump has ignited intense speculation about the possibility of an authoritarian turn in American politics. In some ways, this is not surprising. The divisive political climate in the United States is fertile soil for the demonization of political opponents. George W. Bush was regularly characterized as an authoritarian by his left opposition, as was Barack Obama by his own detractors. Yet in Trump’s case, echoes of earlier forms of authoritarianism, from his xenophobic brand of nationalism and reliance on a near mythological revisionist history, to his vilification of the press and seemingly strategic use of falsehoods, appear too numerous to ignore. In this essay, I attempt to provide a sober evaluation of the authoritarian prospects of a Trump administration. As presidential agendas inevitably differ from campaign platforms, much of this analysis will be unavoidably speculative. However, the nature of Trump’s carefully studied campaign, the early actions of his administration, and the wealth of philosophical reflections on earlier forms of authoritarianism provide ample resources to inform such speculation.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Cross Post: Our political beliefs predict how we feel about climate change

Written by Prof Neil Levy

Originally published on The Conversation

The man who called global warming a fabrication invented by the Chinese to make US manufacturing less competitive is now president-elect of the US. His followers expect him to withdraw the US from the Paris climate change agreement and eliminate the environmental regulations introduced by his predecessor.

But recently, Donald Trump has shown a few signs that he might be open to being convinced that climate change is a real problem requiring action. In discussion with journalists at the New York Times, he expressed the view that there is “some connectivity” between human activity and climate change, adding that he’s keeping an open mind about it.

Will his commitments on climate change go the way of his vow to prosecute Hillary Clinton? I doubt it. I suspect that in the end, the words of his close advisers will be more persuasive than those of climate scientists. He will retain only a figleaf of regulation, at best.

Trump often boasts of his intelligence. Many people might take his scepticism about climate change as evidence against his inflated sense of his own abilities. I don’t think it is. I have no high opinion of Trump’s intelligence, but scepticism about climate change is not the result of a lack of mental capacity or of rationality. The minds of sceptics are not working any less well than those who accept the consensus. They are more victims of bad luck than of bad thinking.

Left-right divide

In fact, there is little relationship between intelligence and knowledge and beliefs on climate change (or other hot button issues, such as evolution).

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

A New Edition of Ethics & Behavior is Now Available

February 22, 2017

Ethics & Behavior (Latest Articles) is now available by subscription only.

Articles include:

  • “Ethical Problems in Planning for and Responses to Pandemic Influenza in Ghana and Malawi” by Evanson Z. Sambala and Lenore Manderson
  • “Assent and Dissent: Ethical Considerations in Research With Toddlers” by Hallie R. Brown et al.
  • “Should We Be Talking About Ethics or About Morals?” by Paul Walker and  Terence Lovat

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Swedish midwife fights for her conscience rights

This week the Swedish Labour Court of Appeal heard the case of a midwife who was sacked because she refused to participate in abortions. Ellinor Grimmark has been refused employment at several hospitals in the Jönköping region because she has declared that abortion is against her conscience and her religious convictions. 

She sued and demanded €30,000 in damages. In 2015 a district court found that assisting with abortions was part of her job, that  her freedom of conscience had not been violated and that she should pay costs of  €96,000.

According to Scandinavian Human Rights Lawyers and the US-based Alliance Defending Freedom, which are jointly handing Ms Grimmark’s case, Article 9 of the European Convention on Human Rights, which is Swedish law since 1995, gives everyone the right to freedom of conscience. In a democratic society this is a right which may only be restricted by necessity. But, say her lawyers, no necessity exists: abortions form a very small part of her job, other midwives are available and there are precedents for accommodating Swedish conscientious objectors:

“Pluralism and dissent on ethical issues is an asset in healthcare, as well as in society in general, and strengthens democracy,” say her Swedish advocates. “A corresponding proportion of patients, also taxpayers, in Swedish society share Ellinor Grimmark’s ethical and/or religious beliefs.”

However, Mia Ahlberg, president of the Swedish Association of Midwives told the BBC that making an exception for Ms Grimmark would destroy the integrity of midwifery and violate women’s rights. The Swedish media is painting the participation of the ADF as a plot by the American pro-life movement to restrict abortion in the European Union.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals – December 2016, Part I by Livia Garofalo

Here is the first part of our December article roundup. Three journals have special issues this month (abstracts in the post below):

Enjoy reading (and what’s left of the holidays)!

American Anthropologist

The Contingency of Humanitarianism: Moral Authority in an African HIV Clinic

Betsey Behr Brada

One consequence of the recent expansion of anthropological interest in humanitarianism is the seeming obviousness and conceptual stability of “humanitarianism” itself. In this article, I argue that, rather than being a stable concept and easily recognizable phenomenon, humanitarianism only becomes apparent in relation to other categories. In short, humanitarianism is contingent: it depends on circumstance and varies from one context to another. Furthermore, its perceptibility rests on individuals’ capacity to mobilize categorical similarities and distinctions. One cannot call a thing or person “humanitarian” without denying the humanitarian character of someone or something else. Drawing on research conducted in clinical spaces where Botswana’s national HIV treatment program and private US institutions overlapped, I examine the processes by which individuals claimed people, spaces, and practices as humanitarian, the contrasts they drew to make these claims, and the moral positions they attempted to occupy in the process. More than questions of mere terminology, these processes of categorization and contradistinction serve as crucibles for the larger struggles over sovereignty, inequality, and the legacies of colonialism that haunt US-driven global health interventions.

Scripting Dissent: US Abortion Laws, State Power, and the Politics of Scripted Speech

Mara Buchbinder

Abortion laws offer a point of entry for “the state” to intervene in intimate clinical matters.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

‘Like a Slap in the Face’: Dissent Roils the AMA, the Nation’s Largest Doctor’s Group

Divisions within doctors’ ranks could make it more difficult for their voices to be clearly heard in the coming clamor to replace the Affordable Care Act with a Republican alternative.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Dissenting from care.data: an analysis of opt out forms

Guest Post: Paraskevas Vezyridis

Article: Dissenting from Care.data: An Analysis of Opt-out Forms

In our article, which is part of a wider project examining the technical, social and ethical challenges of big data in primary care, we simply wanted to explore how varied opt out forms can be when there is no standardised form available. We took as our case study opt out forms from care.data; the highly controversial (scrapped in July 2016) programme of work by NHS England and the Health and Social Care Information Centre (HSCIC) to extract and link (in one central database) healthcare information from GP practices and other NHS and social care services for all sorts of administrative and research purposes. This was an important research question for us since wordings, available options and even design layouts could influence the decision of patients whether to allow the sharing of their GP record for the care.data programme.

While it relies on the individual’s inertia (and often lack of awareness) an opt out is usually considered a more practical and valid approach to consent when compared to an opt in, particularly for low risk, population level studies where highly representative samples are required. For care.data, two types of opt outs were possible: data would either not be extracted from GP records and/or shared outside of the HSCIC in any identifiable form. However, there was no standardised opt out form released, like with the Summary Care Records (SCR). GPs had to come up with their own forms to register patients’ dissent.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

With Sotomayor’s Elmore Dissent, Another Inroad for Neuroscience into Law

Roland Nadler

With the U.S. Supreme Court’s new term officially underway in October, the time has come for court-watchers to once again scrutinize the Justices’ every word for signs of impending developments in the law.  Myself, I’ve never had the confidence in my prognosticating ability to fill out a FantasyScotus bracket, fascinated though I am by the Court as an institution.  But to this autumnal flurry of tea-leaf reading I’ll just add one modest contribution: Justice Sotomayor’s dissent from the denial of certiorari in Elmore v. Holbrook tells us that some basic measure of neuroscientific literacy is going to become more of a necessity for criminal defense lawyers as time goes on.  Counsel who fail to inquire into their clients’ brains will increasingly run the risk that their legal assistance is later deemed ineffective.

In one sense, this is an easy prediction because it is already true.  Work by Nita Farahany and Ellen Koenig, among many others, tells us that neuroscience is — and should be — on the minds of attorneys who wish to avoid ending up on the wrong side of Strickland v. Washington.  All the same, seeing signs of this trend reaching the pages of the United States Reports feels like a significant step.

By way of summary: the petitioner in this case, Clark Elmore, spent much of his childhood and young adulthood being exposed to serious neurotoxins, including pesticides and Agent Orange.  By the time he was in his 20s, he was having clear difficulties functioning in society; a later series of tests would reveal that his capacity for “cognitive control,” that all-important function of the prefrontal cortex that exercises veto power over impulsive emotional behavior, was in the first (i.e.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.