The practice of informed consent in clinical medicine is broken. Globally, the process varies widely, and even in the United States informed consent looks little like the formal, legal, autonomy-based process presented in textbooks, journal articles, and academic lectures.

TRANSCRIPT: February 9, 2021

Around the world, an alarming percentage of Covid-19 deaths occurred in long-term care facilities. Some of these deaths may have been avoided by changes in design. It's time that bioethicists to take a closer look at the built health care environment.

Concerns about the health status of sitting presidents of the United States can raise significant questions in medical ethics, notably regarding the scope of a president’s right to confidentiality and of the public’s need—or right—to know about the president’s health, the role and responsibilities of the president’s physician, and the appropriateness of offering unapproved treatments. These concerns are heightened during the global pandemic for which there is no cure or vaccine and limited information about treatments.

Although the U.S. has the highest health care prices in the world, the specific mechanisms commonly used by other countries to set and update prices are often overlooked, with a tendency to favor strategies such as reducing the use of fee-for-service reimbursement. Many U.S. health policymakers reco...

Artificial intelligence has the potential to reduce inequities in health care and even help restore empathy to the doctor-patient relationship—if, and only if, key ethical barriers are addressed and opportunities grasped. That was Eric Topol’s overarching message at The Hastings Center’s 50th ...

The Food and Drug Administration's rigorous guidance for an emergency use authorization of a Covid vaccine was met by resistance from the White House, since some of the terms would make it virtually impossible to issue a vaccine-related emergency authorization before Election Day. Understanding the ethical dimensions of issuing it for a vaccine can provide clarity on the necessity of the FDA’s stringent guidelines.

Big Data in health care is growing, and it is coming from an increasing number of sources, including electronic health records, patient monitors and physical activity trackers, and smartphone applications. How accurate is this data? What biases does it contain? How do errors and biases ultimately af...

This year’s Intersex Awareness Day, October 26, marks a historic pivot. Last week, Boston Children’s Hospital revealed that its physicians would no longer perform certain nonconsensual infant genital surgeries on babies born with atypical genitals. They join the Ann and Robert H. Lurie Children’s Hospital in Chicago, which made a similar announcement in July and even apologized to its former intersex patients. Intersex advocates have been working toward this goal for decades.

Principal investigator: Diane M. KorngiebelFunder: National Institutes of Health/National Human Genome Research Institute; National Institutes of Health/Office of the Director

How could I, the grandchild of four Holocaust survivors, be obligated to provide not just satisfactory, but exceptional care to such a morally repugnant character?

With all of the tumult surrounding the coronavirus and the upcoming presidential election, few people likely noticed that three important figures in bioethics, medical history, and medical sociology recently died within a month of one another. But for those of us who work in these fields, the deaths...

Years before George Floyd begged to be released from under the knee of Officer Derek Chauvin, Barbara Dawson, a 57-year-old Black woman, died begging a police officer, John Tadlock, not to remove her oxygen mask. Her death occurred right outside the Calhoun Liberty Hospital in Blountstown, Florida, shortly before Christmas in 2015.

As multiple Covid vaccine candidates enter clinical trials and hopefully move closer to approval, one important unanswered question is how to compensate the rare cases of serious vaccine harm.

Covid isn’t merely overshadowing the drug overdose crisis—it’s directly worsening it.

In his recent JAMA article, Donald Berwick eloquently describes what he termed the “moral determinants of health,” by which he meant a strong sense of social solidarity in which people in the United States would “depend on each other for securing the basic circumstances of healthy lives,” reflecting a “moral law within.” Berwick’s work should serve as a call to action for bioethicists and clinical ethicists to consider what they can do to be forces of broad moral change in their institutions.

The United States leads the world in coronavirus cases and deaths. Although many people have called out the inadequacies of our health care system, Covid-19 has exposed the most significant shortcomings. The need for change can no longer be ignored. Here are three lessons from this pandemic that should be leveraged for change.

The rewards of social distancing are beginning to accrue in former hotspots such as Seattle, the New York metropolitan area, and the San Francisco Bay Area, where the number of new Covid-19 cases requiring hospitalization is declining. Assuming the rewards hold in the face of pressures to reopen the economy, hospitals will now face challenges of reopening their own nonpandemic services for patients whose elective surgeries and other procedures were postponed. Which patients should get priority?

Hospitals in the United States are losing money taking care of patients with Covid-19. The pandemic casts a harsh spotlight on the misallocation of health care resources in the U.S.

The Covid-19 pandemic has imposed tremendous risk on doctors, nurses, and other health care workers not seen in a century. It is time to reconsider prioritization of health care workers’ access to scare critical resources. Historically, for multiple reasons, health care workers have not been prioritized for access to medical care during a pandemic. However, given the unprecedented circumstances surrounding the Covid-19 pandemic, it is justifiable to prioritize health care workers when all else is equal between two patients.

As Covid-19 continues to spread throughout the United States, doctors, nurses, and oth-er clinicians are facing unmistakable tragedies. But something less perceptible is afoot. Empathy in medicine is under siege.

The Covid-19 outbreak has forced health care providers, administrative officials, and the general public to each play their part in doing no harm to others. It may come as a surprise to many people, but health care workers may unknowingly spread Covid-19 in their communities simply by wearing scrubs in public.

Previously-stated DNR status would seem irrelevant to ventilator allocation, and yet some existing and proposed guidelines for triage during a public health emergency list DNR status in the list of criteria for excluding patients from getting ventilators or other life-saving health care. This approach is in direct opposition to the generally agreed-upon goal of maximizing the number of survivors, and could result in confusion and public mistrust of the health care system.

This week, the Department of Health and Human Services Office of Civil Rights resolved one of many civil rights complaints alleging discrimination on the basis of disability–the first instance of federal intervention to enforce civil rights laws in rationing protocols since the beginning of the Covid-19 crisis. But more work is needed to protect patients with disabilities in the allocation of scarce medical resources.

As a 71-year-old bioethicist, I consider rationing mechanical ventilation based on age to be one morally relevant criterion during the Covid-19 pandemic.

The views of the New York State Task Force on Life and the Law on ventilator-dependent chronic care patients evolved over the years. Here's how, and why.

There is a lack of clarity about the New York State Task Force guidelines on ventilator allocation. I believe disability rights concerns regarding the recommendations on chronic ventilator users are well-founded. This lack of clarity may cost lives.

I am a member of the New York State Task Force on Life and the Law and helped write its 2015 guidelines on the allocation of ventilators during a public health emergency. The position outlined by the Task Force report has been a point of confusion in the media. I don't believe that the Task Force recommendations discriminate against people with disabilities.

One-third of all new GoFundMe campaigns in the United States are for COVID-19-related needs. This shows where we have failed as a society. It is a makeshift response to institutional failures and not a fair or sustainable solution to crises.

As the U.S. health care system faces the strain of responding to the coronavirus pandemic, critical services are being provided by international medical graduates, who, in the years and months leading up to this crisis, have found their capacity to contribute limited by increasingly restrictive immi...

Nearly 1,400 of the nation’s most prominent bioethicists and health leaders signed an urgent letter to Congress and the White House, imploring the U.S. government to immediately use its federal power and funds to respond to the COVID-19 pandemic as a matter of moral imperative. The petition was developed by Mildred Solomon, president of The Hastings Center, and Lawrence Gostin, a Hastings Fellow and director of the O’Neill Center for National and Global Health Law at Georgetown University.

The Hastings Center has developed a resource for health care institutions and institutional ethics services to support leadership and practice during the novel coronavirus public health emergency and in the care of patients with COVID-19.The Hastings Center convened an expert advisory group to meet the need for a practical resource to support institutional preparedness and supplement public health and clinical practice guidance on COVID-19.

Like most New Yorkers, I take the subway to work. I commute from Brooklyn to my office in Manhattan. By the time I get on the train, there are no seats available. It is nearly assured I will be standing inches away from a stranger.

The theme of National Eating Disorder Awareness (NEDA) week , “Come as you are: Hindsight is 20-20,” is designed to encourage those recovering from eating disorders to reflect on their journeys towards body acceptance. It also affords doctors and other health professionals an opportunity to evaluate how well they are doing to help patients reach this goal.

Tinslee Lewis, a critically ill 1-year-old girl born with a rare heart defect and severe lung disease, has spent her entire life in the intensive care unit at Cook Children’s Hospital in Texas and undergone multiple surgeries in attempts to save her life. Tinslee’s care team has determined that she has no chance for any meaningful survival and that ongoing intensive care is harmful and causing her undue suffering. They recommend withdrawal of life-sustaining treatment, against the parent’s wishes. Tinslee’s fate is being debated in court.

There is big money in using technology to find information in patient and medical staff data. Companies are rushing to cash in. The Food and Drug Administration has approved more than 40 artificial intelligence-based products for use in medicine. Tens of thousands of medical phone apps are tracking patients and gathering detailed medical information about them. These new technologies bring new ethical questions that health care organizations are poorly equipped to answer.

Joel Michael Reynolds, The Hastings Center’s Rice Family Fellow in Bioethics and Humanities and an assistant professor of philosophy at the University of Massachusetts Lowell, is launching a new journal: The Journal of Philosophy of Disability.

Health care in America is at a critical juncture. The number of people who need it continues to grow and costs have skyrocketed. But instead of being a beacon of healing, many health care organizations are beleaguered and overwhelmed. Burnout has become a rallying cry for nurses and doctors because it impedes their ability to uphold the foundational values of their professions and to serve in accordance with them. These realities have eroded the fundamental humanity of health care.

Gretchen Greene, an internationally recognized expert on artificial intelligence policy and ethics, including face and emotion recognition, has been named a senior advisor to The Hastings Center. 

The Compassionate Use Advisory Committee, headed by Hastings Center Fellow Arthur Caplan, of NYU Langone, received the Reagan-Udall Foundation for the Food and Drug Administration’s Innovation Award. The committee was recognized for transforming how expanded access requests, also known as compassionate use requests, are granted by drug developers.

The Compassionate Use Advisory Committee, headed by Hastings Center Fellow Arthur Caplan, of NYU Langone, received the Reagan-Udall Foundation for the Food and Drug Administration’s Innovation Award. The committee was recognized for transforming how expanded access requests, also known as compassionate use requests, are granted by drug developers.

Are we ethically obliged to eat less meat? Bioethicists consider that question, and their role in addressing it.

The Collaborative for Palliative Care, in partnership with The Hastings Center, University of Rochester Finger Lakes Geriatrics Education Center (FLGEC), and Calvary Hospital, will host its annual conference this December 11th at Iona College, New Rochelle, N.Y., titled The Next Generation of Palliative Care: Integrating Palliative and Social Ethics of Care.”

Tremendous wealth beside abject poverty, a widening income gap, the vast disparity between the life prospects of a black child and a white child -- structural injustices are pervasive in our country and many places in the world. What does bioethics have to say about these problems? The Hastings Center has committed to intensifying it efforts to address structural injustices. Ideas for doing so emerged in a plenary session organized by Hastings at the annual meeting of the American Society for Bioethics and Humanities.

The Hastings Center is co-leading a new project to examine recruitment and retention of participants the National Institutes of Health’s All of Us Research Program, an unprecedented initiative to collect genetic and other health-related data from at least one million people living in the United States. This project will focus on a research site that is a health center that serves primarily Latino and African American patients -- groups historically underrepresented in research – to identify strategies to build engagement.

The Hastings Center is pleased to announce the winner of the inaugural David Roscoe Award for an Early-Career Essay on Science, Ethics, and Society.

Amazon.com made waves in health care when it announced that its Alexa Skills Kit, a suite of tools for building voice programs, would be HIPAA compliant. Using the Alexa Skills Kit, companies could build voice experiences for Amazon Echo devices that communicate personal health information with patients. Alexa’s various roles in health care stand to confuse (or potentially exploit) users.

Many survivors of sexual assault are not receiving the justice they deserve. For one thing, an estimated hundreds of thousands of rape kits are left unused, reducing the odds that the perpetrators will be identified and prosecuted. When rape kits are used, many survivors are flooded with bills, in some cases for many years. This system is unethical and illegal.

The American Pharmacists Association Foundation recognized Hastings Center’s Rosemary Gibson with a 2019 Pinnacle Award for career achievement on Monday, September 16. 

Last week, the Department of Homeland Security  announced the final public charge rule, which revises the interpretation of “public charge” in the Immigration and Nationality Act. Under the Final Rule, DHS may find applicants ineligible for a visa for admission to the U.S. or a green card grant...

For the last quarter century, researchers have been asking whether genetic information might have negative psychosocial effects. Anxiety, depression, disrupted relationships, and heightened stigmatization have all been posited as possible outcomes—but not consistently found. What accounts for the ...

The U.S. government is using dental scans to determine if migrant youths are over age 18. The scans are inaccurate for this purpose, and yet they determine if children are sent to adult detention centers.

As artificial intelligence transforms health care, what should be done to assure that it brings about improvements and greater equity? To address those questions, Hastings Center President Mildred Solomon joined a panel at the Aspen Ideas: Health Festival called “Ethical Artificial Intelligence: Oxymoron or Possibility?”

As the opioid crisis reaches a fever pitch, public perception often lumps chronic pain patients and opioid abusers under the stigma-tainted umbrella of drug user. But the full picture of human interaction with pain, pain management, and addiction is far from black and white. In its most recent narrative symposium, Narrative Inquiry in Bioethics published personal stories from those living with chronic pain or opioid abuse disorder. Both groups comment on their need for medical treatment and ethical care.

As the American population ages and dementia is on the rise, The Hastings Center is embarking on pathbreaking research to explore foundational questions associated with the dementia trajectory and the concerns of persons facing this terminal condition. This new research is made possible by a major g...

Should religion play a role in a doctor's care of seriously ill patients? The author, a hematologist/oncologist who teaches Jewish medical ethics, writes: "A physician's outlook may be shaped by religious standards without having to impose it on the patient."

On May 7, New York City officials unveiled details of NYC Care, a new  program in the nation’s largest public health system that aims to improve health care access for about 300,000 low-income New Yorkers who are ineligible for insurance because of their immigration status. The initiative, ann...

Genetics is finally being integrated into the clinic: cancer patients are having their cancer’s genome sequenced, fertility patients are having their embryos tested, and parents are being offered sequencing of their newborn babies.

There is broad support for building health care systems that are patient centered, seen as a means of improving health outcomes and as morally worthy in itself. But the concept of patient-centered care has increasingly merged with the concept of patients as consumers, which “is conceptually confuse...

“Improving patient experience” has become the mantra of many health care facilities in a highly competitive and regulated environment. But just what is it about the patient experience that needs to be improved?  Will better food and gift bags do the trick? Or are more basic changes required?

The introduction of pre-exposure prophylaxis (PrEP) as a means of preventing HIV infections in those at high risk marked a significant step in the fight against the virus. PrEP involves taking the HIV medicine Truvada or a generic version daily. It is now gradually becoming available across the world...

In the wake of the recent Twitter fight between the National Rifle Association and U.S. physician groups over whether doctors should speak out about firearm policy issues, we argue that professionalism actually requires that doctors take a leadership role in gun policy debates, even if (in fact, espe...

Three journalists received The Hastings Center Awards for Excellence in Journalism on Ethics and Reprogenetics. The awards were presented at an event in New York City on December 6 that celebrated the role of journalists in helping the public understand the science of heredity and the power of geneti...

I started writing this on my way back to New York from the Second International Summit on Human Genome Editing, held in Hong Kong November 27 to 29, where the breaking news of the alleged world’s first birth of genetically edited babies loomed large. The surprising news both reinforced and undercut...

Across the country, billboards are popping up suggesting that vaccines can kill children, when the science behind vaccination is crystal clear – vaccinations are extremely safe.

When people ask me what kind of medicine I practice, I most often say family medicine. Now, however, I am also apt to say I practice “democratic medicine.” What is democratic medicine? Less a style than a way of being, it embodies five principles born of democratic values related to history, duty...

Does a new medicine or diagnostic test work? Is it safe? Should the government approve it and insurers pay for it? The answers are not as straightforward as they may seem – and the reasons are the subject of a new book by Karen J. Maschke, a research scholar at The Hastings Center, and Michael K. G...

In 2012, I coauthored a case report about the successful use of dietary supplements in treating a case of male infertility in the American Family Physician. Before it was published, I was surprised to receive a communication asking me to disclose the fact that I had written a textbook on dietary supp...

Immigrants and their families in the United States and migrants who seek asylum in this country face accelerating threats and harms to their health because of the Trump administration’s immigration priorities. A new Hastings Center project, supported by the Open Society Foundations Public Health ...

Last March, 4,000 frozen eggs and embryos were lost at University Hospitals Fertility Center in Cleveland when the temperature in cryogenic tanks spiked due to human error. Officials at University Hospitals have apologized repeatedly to the affected patients, and say that they are working to provide ...

Last month, England announced that it would allow women to take the second pill required for a medical abortion–misoprostol–at home, rather than requiring them to travel to a clinic. The policy brings England in line with Scotland and Wales, as well as many other countries, and it elimina...

A long-anticipated policy change proposed by the Trump administration that would count the use of many federally-subsidized programs against immigrants currently eligible to use them threatens public health and would undermine ethical practice in health professions and systems.

It is legal and common for physicians to prescribe drugs for uses other than those for which they are approved by the Food and Drug Administration. But in a letter in JAMA: The Journal of the American Medical Association, Hastings Center research scholar Karen J. Maschke points to the important role ...

Earlier this month, The Seattle Times published an op-ed by Samuel Browd, medical director of Seattle Children’s Sport Concussion Program, on the risks of brain injury in youth sports. Dr. Browd acknowledged troubling research on the dangers of repetitive brain trauma, but also emphasized that mil...

Twice upon a time, there was a girl who died. The death certificate that New Jersey issued to 17-year-old Jahi McMath on June 22 was the second one issued for her. California issued McMath’s first death certificate in December 2013.  McMath had been admitted to Children’s Hospital Oakland on...

Addyi, a drug that made a splash when it was approved in the summer of 2015 as the first “female Viagra,” is back. Its rise, fall, and rise again is an example of shrewd pharmaceutical marketing and the potential dangers it can pose to patients.

Reports that migrant children held by the Office of Refugee Resettlement are being drugged require an immediate and unambiguous response by the Trump administration. According to court filings, the drugs that are alleged to be among those given to children without their parents’ consent include cl...

The National Academies of Science, Engineering, and Medicine released Physician- Assisted Death: Scanning the Landscape, proceedings from a two-day workshop convened by the National Academies in February to take a comprehensive look at the current landscape of physician-assisted death in the United S...

It’s a little-known and rarely discussed fact of medical practice that doctors value the ability to love our patients. If the thought of doctors loving patients makes you queasy, be reassured. I’m not talking about romantic love but the visceral sense of goodwill and impulse to service that draws...

In April, the U.S. Justice Department announced that it would criminally prosecute migrants who had been apprehended after crossing the U.S.-Mexico. border. An immediate consequence of this announcement, explained in detail here, is the separation of children from their parents.

At a time when facts are distorted, disregarded, and ignored in policy making and political discourse, the need in Washington for seekers and defenders of truth has perhaps never been greater. I discussed the state of affairs with Representative Bill Foster, a Democrat from Illinois who prides himsel...

I usually have trouble finding a good word to say for President Trump’s policy ventures, but his aim to better control out-of-pocket drug costs is worth support. Distressingly, but unsurprisingly, it does not include giving government the needed power to bargain with industry for what it will pay f...

The process is fairly simple. You select one of the companies that offer direct-to-consumer genetic tests; pay online; receive a neatly packed kit that contains a tube designed to collect your spit; return the package using prepaid postage; and wait for the results that will unravel the mysteries of ...

Are you, as caregivers in a twenty-first century health system, helping your patients and families to make fully informed decisions about the treatments they want and that are likely to be in their best interest?  Or, like so many clinicians working in modern health care systems today, are your pati...

In “Tackling Obesity and Disease: The Culprit Is Sugar; the Response is Legal Regulation,” published in the Hastings Center Report, Lawrence O. Gostin describes four coordinated interventions that have been effective at controlling peoples’ tobacco consumption and which can serve as a “powerf...

Many privileges come with having a doctor in the family: appointments squeezed into busy schedules as personal favors, a conspicuous lack of financial strain, an ability to comprehend both treatment plans and health care systems. But familial and professional roles often clash in a health crisis.

The death of former first lady Barbara Bush at age 92 was noteworthy in many ways. She was by all accounts smart, sharp and funny, and a fine, helpful wife to one president and mother to another. Her death last week after a long illness, with her husband at her side, was a model of palliative care su...

When is it acceptable for health care professionals to refuse to provide a treatment because it violates their conscience? The implications of recent developments in federal and state governments that increase protections for conscientious objection were the focus of a panel discussion in New York Ci...

While the U.S. system of organ donation and transplantation is in a state of growth for the fifth year in a row, the call for new strategies to accelerate that progress has never been more robust as the critical need for transplantable organs continues to far exceed the supply. In an article in the M...

In February, Senator Claire McCaskill (D-Missouri) published a report that revealed the unsettling relationship between opioid manufacturers and pain advocacy groups. Focusing on five opioid manufacturers, Purdue, Janssen, Depomed, Insys, and Mylan, the report found that manufacturers contributed $9 ...

The Uniform Anatomical Gift Act, a landmark law adopted 50 years ago this summer, has provided a sound and stable legal platform on which to base an effective nationwide organ donation and transplantation system, as we discuss in our article in the current issue of the Hastings Center Report. We work...

“It was like he thought we were dirt.”

Hastings Center president Mildred Z. Solomon and director of research Josephine Johnston were featured speakers at the premiere screening of The Code, a series of three documentaries on the origins of genetic medicine and what its successes and failures mean for the future. The series was produced by...

An article in the Hastings Center Report asks whether it is ethical to ration health care by inconvenience and red tape. In other words, given that all societies must ration health care in one way or another, is it ever ethical to push people away from an unpreferred health care option by making it m...

In a recent essay in Vogue the actress, writer, and director Lena Dunham described her decision to have a hysterectomy at age 31 after a decade of unsuccessful attempts to control increasingly excruciating pain from endometriosis. The decision was difficult because it meant that she would never be ab...

An opinion piece in the New York Times, “Doctors Fail Women Who Don’t Want Children,” serves as a striking reminder that the more things seem to change, the more they stay the same.

A transgender woman has successfully breastfed a baby. This case has been hailed as a “breakthrough” for transgender families. I will argue that being transgender is only peripherally relevant, and the potential risks to infants are unjustified.

“It felt selfish to put my baby at serious risk by pursuing a vaginal birth,” writes Kristen Terlizzi in a collection of essays published recently in Narrative Inquiry in Bioethics. You can read Terlizzi’s full story here.

In January the Department of Health and Human Services acted to increase enforcement of laws that permit doctors and other health care workers to refuse to provide services such as abortion because of moral or religious objections. A new Conscience and Religious Freedom Division in the department’s...

Hurricane Harvey dissipated in September, but much of the destruction that it wreaked on Texas and Louisiana remains. When addressing residential concerns, disaster relief officials prioritize the newly homeless over the chronically homeless, choosing to protect the previously privileged over the unp...

It’s one o’clock in the morning in the pediatric intensive care unit.  A 16-year-old patient tells his nurse that he disagrees with the medical treatment plan that was agreed to by his parents. While he is legally a minor, he may have the capacity to make his own medical decisions. He is...

Vulnerable. Entitlement. Diversity. Transgender. Fetus. Evidence-based. Science-based. Last week, news outlets reported that the Centers for Disease Control and Prevention had been advised to avoid using these seven words in budget documents. In an interview with Medscape Hastings Center research sc...

As modern medicine improves survival odds, many young cancer patients are living long lives that bear the markings of the disease and its treatment. The side effects of chemotherapy, radiation, and surgery often include damage to fertility, such as early menopause or the loss of viable sperm. A recen...

Nominations have been extended to January 22, 2018 for The Hastings Center Cunniff-Dixon Physician Awards, which recognize physicians in the United States who give exemplary care to patients nearing the end of life. The awards commend doctors  who provide outstanding care at the bedside, serve as mo...

The arrest of Jumana Nagarwala and her colleagues, in what has become the first case to be tried under the federal law prohibiting female genital mutilation, has brought female genital cutting practices into public conversation once again. Dr. Nagarwala, an emergency medicine physician from a small S...

When you donate a sample of blood or saliva for research purposes, is it your property? What about the genetic and other data it contains? Should you be allowed to specify the type of research it is used for? These and other ethical questions are at the heart of a new book, Specimen Science: Ethics a...

Do the recipients of organ transplants have a right to know if the organs they are about to receive were part of a research study? If so, are the recipients themselves research subjects? A recent article in the Hastings Center Report maintains that the recipients do have a right to know, but that the...

Along with the recent public debates over  Confederate memorials, there have been calls to remove or modify the statue of Dr. J. Marion Sims, called the father of gynecology in medical histories, who conducted horrific experiments on enslaved black woman.   Removal of the structures alone will not...

The first gene therapy for cancer, approved by the Food Drug Administration in August, will transform the treatment of a particular kind of cancer in children and young adults.  It’s transformative because it uses a patient’s own immune cells to attack the cancer cells. The hope is that this is ...

An  article in the New England Journal of Medicine last March warned of the “chilling effect” of recent federal immigration policy changes on health care access for undocumented immigrants. The Trump administration’s expanded immigration enforcement has seen an increased number of arrests at m...

My  colleague Susan Reverby surely got this right: It is time to consider anew what to do about Dr. J. Marion Sims, that is, what to do about the New York City statue that commemorates him, and accordingly, about the medicine, history, and bioethics that have remembered and/or revered him. The works...

The magnitude of the opioid epidemic is increasing across North America, stretching its harmful reach across socioeconomic borders. Drug overdoses are currently the number one killer of Americans under the age of 50. Reports suggest that in the next decade the opioid epidemic could kill more people t...

The case of Charlie Gard continued to unfold this week as Charlie’s parents, Connie Yates and Chris Gard, withdrew their appeal for permission to bring him to the United States for experimental treatment. The move came after tests showed that Charlie had sustained irreversible muscle damage, making...

In 1971, the United Nations passed a resolution prohibiting its member nations from advertising psychotropic drugs to the general public. More than 40 years later, this resolution has done little to halt pharmaceutical companies from marketing stimulants as treatments for attention deficit-hyperactiv...

Three years ago, a small pharmaceutical company with a big agenda created a fake feminist group so that they could get a bad drug approved by the Food and Drug Administration. The story of how this happened is a case study in how industry affects medical discourse, the subject of a PharmedOut confere...

Danielle is a 15-year-old transgender female who is about to begin hormone therapy. Her parents would like her to explore gamete cryopreservation – sperm freezing – as a means of preserving her fertility, which could be impaired by the hormone treatments. Danielle would prefer not to, remarking, ...

Artificial intelligence, gene editing, synthetic biology – these are among the new technologies discussed at Governance of Emerging Technology 2017, organized by Arizona State University College of Law and cosponsored by The Hastings Center, which took place in Phoenix on May 17 – 19. Hastings Ce...

It’s unusual for a funder to recognize that large societal problems are best addressed after deep reflection and a deliberate and inclusive process of consultation and priority-setting.  “But then,” says Mildred Z. Solomon, president of The Hastings Center, “The Robert Wilson Charitable Trus...

On May 4, 2017, just over one month after abandoning a previous version of the bill, the U.S. House of Representatives voted by a 217-213 margin (with one abstention) to adopt the American Health Care Act (AHCA). During the coming weeks and months, most of the political commentary will focus on the s...

The Hastings Center teamed up with the Association of Health Care Journalists (AHCJ) to create three sessions on gene editing for its annual meeting in Orlando on April 20. In addition, Hastings Center research scholar Nancy Berlinger was a panelist on a session concerning health care for refugees an...

In 2008, The President’s Council on Bioethics turned to Immanuel Kant and his deontological philosophy as a resource for deliberations on contemporary bioethical issues.  The report focused on Kant’s understanding of human dignity, and his deduction that the value of a human is intrinsic.  The ...

Why doesn’t Medicare pay unconditionally for amyloid PET imaging, a brain scan that identifies whether patients have beta amyloid plaque in their brain tissue, which may be a contributing factor for Alzheimer’s disease? This question is at the heart of current disputes about health technology ass...

People value their health. It allows them to pursue their aims and enjoy their lives, and it contributes to their well-being. But health is not only good for particular healthy individuals. It is also good for their families, communities, nations, and in a world in which people flows are global, heal...

Given the chance, would Supreme Court nominee Neil Gorsuch vote to overturn Roe v Wade? Challenge state "death with dignity" laws?

Imagine you are a doctor running a clinic in a primarily lower-income neighborhood, where many of your patients are recent immigrants from different parts of the world. You are granted a fixed annual budget of $100,000 through your local public health department, and it is unlikely that you can obtai...

On February 21, the Department of Homeland Security released new policies prioritizing deportation of undocumented immigrants. Will this policy shift affect health care access for this population of 11 million? Two public health studies from Arizona suggest that immigration crackdowns change health-s...

How do state and local health care systems care for seriously ill undocumented immigrants? This question is the focus of a collection of articles in JAMA Internal Medicine. Nancy Berlinger, a Hastings Center research scholar and coauthor of one of the articles, “The Illness Experience of Undocument...

On December 13th, President Obama signed the 21st Century Cures Act, a bipartisan, multidimensional health research and development bill.  The act allocates $4.8 billion to the National Institutes of Health and $500 million to the Food and Drug Administration over the next 10 years for research and ...

Health care access is local; creating, financing, expanding, or restricting health care access for a low-income population involves local, state, and federal policies. During the Obama administration, health insurance for the estimated 11 million undocumented immigrants in the United States remained...

The recent report by the National Center for Health Statistics showing a decline in life expectancy in the U.S. in 2015 highlights a point largely overlooked in post-election discussions about health policy under the Trump Administration. The significant increases in health insurance coverage under t...

Academic bioethics has never been popular with Republicans. Libertarians dislike academic bioethics because it seems too elitist and anti-free market.  Religious thinkers worry it is technocratic, soulless and crassly utilitarian. Now with Trumpism add a populist disdain for expertise, experts and t...

The November issue of the AMA Journal of Ethics is devoted to transgender health and medicine. Contributors include Elizabeth Dietz, a project manager and research assistant at The Hastings Center, who is co-author of “How Should Physicians Refer When Referral Options Are Limited for Transgender Pa...

Writing in the Health Affairs Blog, Hastings Center president Mildred Solomon says that the Food and Drug Administration’s controversial decision to approve the first drug for Duchenne muscular dystrophy is defensible, but only if there is adequate follow through. Read the post here.

Telemedicine is becoming more widespread. This is care at a distance, where patient and clinician are connected by information technology that may include video, audio, and monitoring equipment linked by computer. Telemedicine has many advantages. It can bring expert care and support to people in rem...

On September 21, Heather Bresch, CEO of Mylan, took heat at a Congressional hearing about high EpiPen prices. EpiPens are definitely overpriced – but they are also overprescribed.

Drug spending in the United States increased more than 12 percent in 2014 and is projected to rise faster than overall health care spending over the next 10 years. Between 2007 and 2016, the price of a pair of epinephrine autoinjector EpiPens, used to counter life-threatening allergic reactions, rose...

High drug prices are a fact of modern American life. They are not, however, equally high for all Americans. Their magnitude depends on whether you are un-, under-, or adequately insured, and also whether or not you are an insurance company. Insurance companies routinely negotiate for lower-than-list ...

Hastings Center research scholar Nancy Berlinger is an author of a new policy statement on palliative care issued by the American Heart Association/American Stroke Association. The statement makes recommendations on how to reduce barriers that prevent many patients with heart disease and stroke from ...

Perhaps we were naïve. Our plan was relatively simple: we would chart the legislative evolution of programs for veterans with traumatic brain injuries (TBI) to identify policy gaps for this underserved and vulnerable population. With recent media attention highlighting the U.S. Department of Veteran...

Much of the conversation about conscience in health care has focused on the ethics of physician refusal to perform procedures that they object to. However, this framework seems insufficient for thinking about contemporary abortion provision, where new legislation is routinely passed to restrict the a...

As President Barack Obama’s term comes to a conclusion, various initiatives started under his administration remain unfinished.  One of these, the adoption of the recommendations of the Defense Health Board (DHB), “Ethical Guidelines and Practices for U.S. Military Medical Professionals,”  is...

When the Tribeca Film Festival canceled its controversial screening of Vaxxed, a “documentary” (with scare-quotes) alleging a Centers for Disease Control cover-up of the debunked vaccine-autism link, it vindicated what scientists have collectively been saying for years: There’s nothing t...

Sometime around my mid-50’s I began to ask myself a question: how long should I want to live? My father had died at 64, my mother at 85, my various uncles and aunts in their 60s and 70s. Occasional news stories, always with a picture, reported on those few people who made it to 100. I am now 85 an...

Canada is on track to enact one of the most permissive assisted dying legislations in the world, comparable with laws in the Netherlands and Belgium.

Should people suffering from psychiatric conditions, such as severe, prolonged depression, that have not responded to treatment, be eligible for physician-assisted death? Most jurisdictions that allow PAD do not permit it for psychiatric conditions. However, though rare, it is allowed in Belgium and ...

At the end of an otherwise quiet night, we were paged to the emergency department for a stat trauma. A man with multiple gunshot wounds was wheeled by paramedics into the trauma bay, his blood pressure perilously low. The surgeons searched his body for blood. They cut off his clothes and rolled his ...

Last month, the New York Times reported that the price of a 62-year old little-known drug, Daraprim (pyrimethamine), rose overnight from $18 to $750 a pill. About 100 pills are needed to treat toxoplasmosis, a disease caused by a parasite that lives inside a third of humans but can cause life-thre...

Three weeks ago, my dear friend Jackie, a internationally recognized bioethicist in her fifties who lives in Newcastle-Upon-Tyne, went to bed with what she thought was a bad case of flu. A few days later she was really ill, and her partner and another dear friend persuaded her to go to an emergency c...

I had just turned 5 in November 1994 when my fellow Californians voted to pass Proposition 187 in a draconian attempt to restrict undocumented immigrants from receiving health care, education, and other services, as well as to require doctors, teachers, and others to report those suspected of viola...

The Patient Protection and Affordable Care Act (ACA) relies on three primary strategies for expanding health insurance coverage. First, it regulates the insurance market to prevent practices that made it difficult or impossible for sick people to purchase insurance. Second, it expands Medicaid dram...

Decades of experiments have shown that rats are smart individuals that feel pain and pleasure, care about one another, can read others’ emotions, and will help unfamiliar rats even at a cost to themselves. It’s time to apply what we’ve learned from these animals and stop conductin...

I was only there to learn how to place IV lines. But as my anesthesia attending and I gathered our needles, tourniquet, and gauze, I noticed that our patient, whom I’ll call Jamie, didn’t appear to fit into a narrowly defined version of gender. I wasn’t sure whether to refer to Jamie as she, he...

On April 1, a $1 billion lawsuit was filed by three law firms based in the United States and Venezuela against Johns Hopkins University, the Rockefeller Foundation, and Bristol-Myers Squibb on behalf of more than 750 Guatemalans alleged to have been harmed when the U.S. Public Health Service and the...

Branded as “The Little Pink Pill” and “Female Viagra,” flibanserin, Sprout Pharmaceuticals’ only drug, was recently resubmitted to the Food and Drug Administration for approval for hypoactive sexual desire disorder (HSDD), a questionable condition promoted by pharmaceutical companies to sel...

I would guess that most Americans, even Jewish Americans, had never heard of metzitzah b’peh until the recent controversy between ultra-Orthodox Jews and the New York City Department of Health. This phrase, translatable as suction by mouth, refers to a custom performed after a circumcision in which...

This week the Presidential Commission for the Study of Bioethical Issues released a brief, Ethics and Ebola: Public Health Planning and Response,to the administration and the public on ethical preparedness for public health emergency response, with a focus on the U.S. response to the current Ebola e...

After having been virtually eliminated in the United States in the year 2000, measles have made a comeback, with nearly 150 cases in 17 states and nearly 30 confirmed cases of the illness in the Canadian provinces of Ontario, Quebec, and Manitoba.

The current measles outbreak has brought public attention to the ease with which vaccine exemptions are available. As the media continually inform us, 48 states allow for religious exemptions, while 19 states also offer exemptions based on some sort of personal philosophy. The New York Times feature...

When she was 18, Carmen Guadalupe Vasquez Aldana was sentenced to 30 years in jail. Her crime was delivering a stillborn baby. She was suspected of having had an abortion. While her  sentence was overturned on January 21,  her original conviction of homicide was the result of Article 1 of El Salv...

Recently it has been argued that cardiopulmonary resuscitation (CPR) should, as a matter of policy, not be offered to persons with Ebola disease. Such a categorical restriction of CPR based solely on a patient’s diagnosis rather than his prognosis would be unique in modern medical practice. Beyond ...

The Choosing Wisely campaign is one of the most exciting experiments in health care in quite a while. If it lives up to its potential, Choosing Wisely could prevent some of the harm caused by unnecessary tests and treatments, while helping to bring down medical costs. But the real challenge to the ...

“The capacity for suffering and enjoying things is a prerequisite for having interests at all, a condition that must be satisfied before we can speak of interests in any meaningful way,” –Peter Singer

As health care institutions in the United States prepare for Ebola patients, many have adopted the policy that those providing hands-on care should come from a pool of volunteers. Given the mixed history of health care providers’ willingness to care for patients during epidemics and pandemics, an...

While details of the deaths of patients in Dallas and Madrid from Ebola are not public, their passing prompts questions about resuscitation in individuals infected with the virus. To date, this question has not been raised in clinical ethics. We must now consider whether unilateral do-not-resuscitate...

The crisis and failure of caregiving that have engulfed the Veterans Health Administration cannot be solved with increased resources or even by hiring more doctors and nurses. Additional resources are critical and necessary—but they are not a sufficient long-term and comprehensive solution to a pro...

The Supreme Court’s ruling in Burwell, Secretary of Health and Human Services, et al. v. Hobby Lobby Stores, Inc., et al., could undermine a central goal of the Patient Protection and Affordable Care Act (ACA): to expand access to health care by creating a system in which access to health care is ...

The director of the medical intensive care unit did not like the idea of having a bioethicist around. But she agreed to the request, and there he was on rounds, most mornings for several months. The year was 1986.

Several weeks ago, the Accreditation Council for Continuing Medical Education (ACCME) announced a new rule banning corporate logos from accredited educational materials for physicians. The ACCME sets standards for the continuing medical education (CME) that most practicing physicians must obtain in o...

The American health care industry is undergoing a transformation in several respects, including the substantial integration and consolidation of health care providers. Three of the leading ways in which this is taking place are through mergers of hospitals and health systems, development of accountab...

It is hard to quibble with the fact that Dr. Daniel Mascarenhas is breaking the law. It is also hard to quibble with the fact that he is a hero.

I appreciate Dr. Benatar’s essay on the role of bioethics in confronting the challenges of global health inequities. His article aptly catalogues the contributing factors–both specific to health and otherwise–that weigh heavily on our unequal world. More importantly, Dr. Benatar’s focus on ...

A new debate is surging through the gay male population in the United States: should gay men take a drug that can reduce their risk of contracting HIV? The drug in question is Truvada, a combination antiretroviral commonly used to treat HIV infection. In 2012, Truvada was approved by the U.S. Food a...

Two cases involving “brain death” have received considerable public attention, including commentary by several well-known bioethicists. In commenting on these cases the bioethicists have stated, in no uncertain terms, that an individual correctly diagnosed as “brain dead” is dead, pure and si...

Geylang is the red-light district of Singapore, east of the city center. It would be easy, and wrong, to describe Geylang as a different world from the skyscrapers and malls of the contemporary, booming city. Its restaurants and its vernacular “shophouse” architecture link its street culture to o...

Ethicists and others have been concerned that the disclosure of genetic information to patients might have negative consequences. The suspicion has been that negative effects, say, becoming depressed, are particularly likely when people are being informed about predispositions to diseases that are no...

The New York State Task Force on Life and the Law released its Report and Recommendations for Research with Human Subjects Who Lack Consent Capacity today, which analyzes the ethical and legal implications of involving cognitively impaired adults to participate in human subjects research (HSR). Th...

After the Hastings Center Report published my essay on Mayor Bloomberg’s health legacy­ — with its key ideas spread through the popular media (here and here) — vitriolic messages streamed into my inbox. The messages were not intellectual arguments supporting free enterprise or limited governme...

Last summer’s revelations that malnourished Aboriginals in Canada served as unwitting and unprotected subjects in nutritional experiments in the 1940s and 1950s brought a sharp reaction–though the research took place decades ago, the pain in Canada’s First Nations communities was fresh. First N...

In the November-December issue of the Hastings Center Report I wrote about voluntary sterilization for childfree women. The article came about through my inability to get sterilized as a childfree woman. I had never wanted children. In college I met a man who felt the same way. We fell in love a...

In the current issue of the Hastings Center Report, two teams of physicians and ethicists at Penn State consider the ethics of using online research and social networking tools to learn more about a patient who came to them with a request for a prophylactic bilateral mastectomy. The patient’s s...

Smoking-related illnesses cost the United States hundreds of billions of dollars a year in health care expenditures and lost productivity, and claim hundreds of thousands of lives.” Given the enormous medical and economic toll of smoking, it is not surprising that 58 percent of Americans favor ch...

The salience of the Constitution’s spending clause to the public’s health is not often appreciated–empowering the federal government to “provide for the common Defense and general Welfare.” But the power to spend–along with the equally vital power to tax–provides government with authori...

Loyola University Chicago Stritch School of Medicine’s recent announcement that it would accept applications from Dreamers – young undocumented immigrants eligible for Deferred Action on Childhood Arrivals (DACA)status – is an innovative and welcome response to the promise implicit in DACA....

Sport-related concussions are a significant public health problem, and concussion management is one of the most controversial issues in sports medicine. The latest international consensus statement on concussion in sport advises that players not return to play on the same day they were injured a...

AIDS in New York: The First Five Years is an exhibit running this summer at The New-York Historical Society, an organization so venerable that its name reflects how the city’s name was originally spelled.  The exhibit works on several levels: historically, as a story about how one city and region...

Three years before beginning medical school, I got off a bus in Granada, Spain and met the family I would be living with for four months. My host parents, Carmen and Monolo, introduced themselves and asked how old I was, where I was from, and how many sisters and brothers I had.  Within a few minute...

In a recent article in the Hastings Center Report, Daniel Callahan argues that obesity is a serious public health problem facing the U.S. and suggests a variety of strategies for combating this problem. The article has provoked a great deal of public attention on blogs and web news sites since its...

In a recent article in the Hastings Center Report, Daniel Callahan argues that obesity is a serious public health problem facing the U.S. and suggests a variety of strategies for combating this problem. The article has provoked a great deal of public attention on blogs and web news sites since ...

Since the 1960s, obesity has become one of the most significant health problems in industrialized nations. In the U.S., the percentage of obese adults increased from 13 percent in the 1960s to 32 percent in 2004. According to some estimates, 41 percent of U.S. adults will be obese by 2015 and 75 p...

In his article, “Obesity: Chasing an Elusive Epidemic,” published in the Hastings Center Report, Daniel Callahan posits that obesity is so widespread and embedded in our culture that most if not all efforts to combat it have failed, and failed miserably. Change, in a large and most revolutionary...

Nearly everyone agrees that obesity is a significant public health problem in the United States, and nearly everyone agrees that the public health responses to it so far have been disappointing.  So what should be done about it? In the January-February issue of the Hastings Center Report, an arti...

The previously obscure ultra-Orthodox Jewish rite of metzitzah b’peh (oral suction) has burst into the news lately and raised critical questions about genital surgery, consent, First Amendment rights, tradition, and the representation of Jews. I would guess that most Americans, even Jewish-Amer...

TEDMED, which took place in Washington last week, was a beehive of doctors, nurses, medical students, leaders of medical institutions and government health agencies, entrepreneurs, engineers, patients, patient advocates, athletes, musicians, artists, poets, and, yes, bioethicists — a diverse...

Is there an ethical case to be made for questioning the homespun wisdom, “An ounce of prevention is worth a pound of cure?” An argument along those lines caught a lot of attention when it was made in the Hastings Center Report 35 years ago by philosopher Benjamin Freedman. Now, on the 15thanni...

I am still in medical school, but today I sigh the frustrated, disapproving sigh of a fully trained doctor. “You know,” I scold the middle-aged man in front of me, “you really should start eating better.”

Patients diagnosed as being in a persistent vegetative state have figured prominently in the law and medical ethics relating to end-of-life decisions since the case of Karen Quinlan in 1976. These patients have profound brain injuries that leave them in the seemingly anomalous condition of being awak...

The demise of the CLASS (Community Living Assistance Services and Support) Act is the calamitous result of ideological warfare and political cowardice. It would have provided a modest benefit – a basic guaranteed lifetime benefit of at least $50 a day in the event of illness or disability to be use...

Another landmark right-to-die case hit the U.K. headlines last week. A High Court judge ruled, in W v M & Ors [2011] EWHC 2443 (Fam), that a 52-year- old woman in a minimally conscious state (after contracting viral encephalitis nearly 10 years ago) cannot be allowed to die (by having artificial ...

Reading Frank Bruni’s recent review in the New York Times of Provocateur, a chic bar in the meatpacking district, got me thinking about an argument I’d had recently with a family practice doctor. It’s true the argument had driven me to drink, but that wasn’t the essence of the connection betw...

I’d like to say I was shocked when a colleague sent me the warning letter from Eli Lilly relaying results of a French study that indicate a 30 percent increased risk of death among children treated with recombinant human growth hormone (rhGH) in attempts to make them taller.

It was one of those messages I get occasionally, this time from a man who had suddenly realized we were just a few blocks away from each other. The writer’s father was at a nearby Northwestern hospital, suffering from a terminal cancer.

In my e-mail in-box a few weeks ago, I received a polite message from a woman named Sarah Hoffman who was writing to ask why I was being such a gender conservative. Sarah didn’t quite put it that way, but that was the gist of her message, and given that I’m usually accused of being a gender ra...

I was invited to join the Seattle Growth Attenuation and Ethics Working Group — collective author of the lead article in the current issue of the Hastings Center Report — but I begged off, claiming I had too many other things on my plate. True, but the bigger reason for avoiding the proj...

In “The Rhetoric of Dehumanization: An Analysis of Medical Reports of the Tuskegee Syphilis Project,” Martha Solomon brilliantly demonstrates how the project’s researchers hid their work in plain sight. Specifically, Solomon used the published reports of the Tuskegee syphilis study – which in...

If you’re trying to make sense of the “decisions” just made in Miami about sex-typing in sports, and you’re struggling, join the club.

What is medicine for? I found this question on my mind recently, not only because I had been discussing it with a group of thoughtful medical students to whom I was teaching the history of medicine, but also because I was shopping for a bra at Bloomingdale’s.

As a wizened gender rights advocate, I know better than to assume the activists making the most noise are actually representative of “the community” they insist they represent. So, while American transgender activists have lately been fairly unified and very vocal about the need to remove “Gend...

This past week, the AMA officially issued a “mea culpa” for its history of engaging in discrimination against African-American physicians – except it’s more like a “they-a culpa,” since the AMA administrators are actually apologizing for bad behavior on the part of their predecessors. �...

A dwarf walks into a bar.

For years, the abortion of fetuses likely to have disabilities has been called “selective abortion,” but, for reasons made clear in Hilde Lindemann’s thoughtful Bioethics Forumreflection on the matter, the practice might better be called “selective parenting.” It fundamentally reflects, aft...

Deborah Costandine and I met in June of 2004, but she didn’t send me the autopsy report of her baby for another year and a half. So I didn’t start looking for more information about what had happened to her until January of 2006. That’s when Deb wrote to say she was wanted some help, so that’...

Because I’ve acted as a professional advocate for people born with norm-challenging bodies, quite a number of strangers and familiars have been writing to ask me what I think of the “Ashley Treatment.” Nine-year-old Ashley’s parents decided to remove their severely cognitively-impaired daught...

On Tuesday, the New York Times reported that New York City “is moving forward with a plan to let people alter the sex on their birth certificates even if they have not had sex-change surgery.” Under the new plan “being considered by the city’s Board of Health… people born in the city would...

As if we didn’t have enough reasons to wish for better informed consent practices in the United States, here’s another: evidence that, if physicians spent more time seeking truly informed consent – telling patients what the best available studies show about their options – their patients migh...

When I was a student, I loved to read Freud and Nietzsche and Marx. I was into what the great French philosopher Paul Ricoeur called “the hermeneutics of suspicion.” Sex, power, and money were at work everywhere. So were the psychological and social mechanisms that kept everybody else fro...

So, a new randomized control trial comes out showing that circumcision in adult males can dramatically reduce HIV infection rates, and all my friends who opted for circumcising their baby boys are holding up the dozens of national news accounts of this saying to me, “See?! See?!” Like I j...