In the more than 35 years since federal legislation created organ procurement organizations (OPOs) to recover organs from deceased donors for transplantation, there has been a disparity in their performance, with the best OPOs recovering organs from four times as many donors as the worst OPOs by obj...

Should Patients Take It? Monday, July 12, 2021

A HASTINGS CENTER CONVERSATION WITH RHEA BOYD, MAYA GOLDENBERG, AND MILDRED SOLOMON The Hastings Center hosted “Vaccine Access, Vaccine Hesitancy: Challenges to Herd Immunity,” an online discussion of the ethical issues related to vaccine access and hesitancy in the United State...

TRANSCRIPT: February 9, 2021

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...

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

The Covid-19 pandemic continues to test and occasionally overwhelm health care institutions. Many practitioners may face the ethically challenging scenario of having to ration ventilators while triaging patients in “crisis care.” Ventilator shortages have led to innovative ventilator design “hacks.” Are these improvised ventilators ethical?

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

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...

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...

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...

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.

In an earlier piece, “Trumping Drug Costs,” I looked at out-of-pocket costs as the pivotal issue with drugs. They can be a particularly heavy burden on the elderly, taking money from their savings and a large bite of their Social Security income. Along the way, I also looked at out-of-pocket medi...

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...

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...

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...

With Senator John McCain’s heroic return and Vice President Mike Pence’s tie-breaking vote on a health care bill July 25, Senate Republicans managed to cobble together 51 votes simply to agree to debate health care reform. This razor’s edge victory is diagnostic. Hyperpartisan debate is conv...

There is a broad and deep moral conviction that health care should be distributed according to genuine need and not left to the cold mercy of pure market forces or the logic of actuarial fairness. Unfortunately, the proposed American Health Care Act (AHCA), passed last week in the House of Representatives, and other legislation threaten to undermine that moral commitment.

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...

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...

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...

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...

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 ...

The December 2015 United Nations meeting on climate change was an historic moment for global efforts to reduce harmful carbon emissions. While it gained the agreement about the future good of the planet, it made clear that there is a long and hard road still ahead. Yet another global challenge is ...

I said that in focusing on abstract science and policy arguments against right to try laws, experts (and here I meant to include ethics experts) have neglected the power of stories.

The Supreme Court announced that it will hear a legal challenge to President Obama’s 2014 executive action to protect an estimated five million undocumented immigrants from deportation and permit them to work legally. The implementation of the Deferred Action for Parents of Americans and Lawful P...

Hastings Center scholars Michael Gusmano and Nancy Berlinger have been named to a bioethics steering committee for a new White House initiative to improve the diagnosis, treatment, and care of people with cancer in sub-Saharan Africa.

The American Psychological Association (APA) voted at its 2015 meeting to ban psychologists from participating in national security interrogation programs, including torture. The policy change was in response to the public outcry over the release of unsettling Senate Intelligence Committee’s re...

This month France’s highest court granted legal recognition to children born to surrogates. Previously, surrogate children were deprived of any legal connection to their parents, or any civil status in France. They could not get ID cards or passports, or register for state health care or other bene...

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...

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...

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 ...

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...

New York City Mayor Bill de Blasio recently announced a plan to connect unaccompanied minors who have arrived in the city from Central America with public education and health care through the legal system. Between January 31, 2014 and August 31, 2014, 4,799 children have been released to sponsor...

In a recent New York Times op-ed, David Brooks observes that governance, in the form of multilateral organizing, is missing from the response to the Ebola epidemic in West Africa. Unfortunately, global organization and health infrastructure building too often occur in the midst of a public healt...

Beyond crucial questions of fair access to scarce supplies of the experimental drug ZMapp and to other potentially effective drugs to treat Ebola, commentators from bioethics, public health, journalism, and other sectors are increasingly focused on “staff, stuff, and systems.” The consequences ...

Wendy Chung’s commentary last month about the FDA’s proposed draft guidance for the regulation of laboratory-developed tests (LDTs) is heavily critical of the agency’s plans. Professor Chung argues that the FDA’s involvement in this space will have two primary negative consequences: it will...

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 ...

From October 1, 2013, through June 15, 2014, more than 52,000 child migrants crossed the U.S.-Mexico border in South Texas, overwhelming the U.S. Customs and Border Patrol and the Department of Homeland Security (DHS). The Obama administration has declared this an “urgent humanitarian situation�...

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 ...

The state of global health is a major concern. Despite advances in medicine and medical care and massive growth of the global economy, health in the world is characterized by widening disparities within and between countries; lack of access to even basic health care for billions of people; the emerge...

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...

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...

I mostly agree with Lawrence Gostin’s paean to outgoing New York City Mayor Michael Bloomberg in the Hastings Center Report. Like Gostin, I see Bloomberg as a public health innovator who has tested the boundaries of government power in productive ways. Gostin helpfully summarizes—and then refutes...

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...

On November 14, President Obama announced that he would delay by one year the implementation of requirements imposed by the Patient Protection and Affordable Care Act(ACA) that would have led to the cancellation of some low cost health insurance plans. The president felt compelled to do this becau...

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...

“’The lower the caste,’ said Mr. Foster, ‘the shorter the oxygen.’ The first organ affected was the brain. After that the skeleton.” In Brave New World cognitive ability is carefully and intentionally bred out of the lowest rungs of society. Although he was writing fiction, Aldou...

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...

As any philosopher worth his or her salt can tell you, health insurance is not among the array of topics in Plato’s corpus. Even so, a lesson on citizenship from one of his more famous dialogues, “Crito,” can teach why the insurance mandate in the Affordable Care Act ought to make sense to u...

A recent editorial in Nature lauds the U.S. government for its efforts to promote open communication between government scientists and journalists, but it condemns the Canadian government for its opposing efforts to limit what federal scientists can freely communicate to journalists. TheNaturecr...

“Pink is the new wire hanger.”  In the flurry of tweets that followed in the wake of the debacle between Susan G. Komen for the Cure and Planned Parenthood, this one was my favorite. It combined two powerful symbols in women’s health–the pink ribbon of the breast cancer movement and...

A recent editorial in The Lancet issued a dire warning to the international medical community: medicine is a weapon of war in Syria. It is just the latest in a series of reportsfrom across the Middle East on how medical care and medical professionals and facilities are being used to inflict poli...

The Obama administration’s decision regarding Catholic institutions and coverage for reproductive health has stirred up a firestorm of claims that the policy restricts religious freedom. That’s true: the policy does restrict religious freedom to an extent. But while freedom of religion is sur...

Unless you’ve been living under a rock for the past few weeks, you’re now well aware of the otherhealth care mandate. The Affordable Care Act requires insurers to cover “preventative health services” without charging a copayment, co-insurance, or a deductible, and the Obama administra...

Last week, NPR reported a major humanitarian group’s decision to stop treating patients from detention centers in Misrata, Libya. According tothe report,“torture was so rampant that some detainees were brought for care only to make them fit for further interrogation.”

Many in the health policy world worried when President Obama made only passing reference to health care in his State of the Union Address — only two mentions of the words “health care” and one each for “Medicaid” and “Medicare.” While there may be a number of reasons that Obama c...

Despite the persistent focus on economic growth, jobs, and global competition in the Republican presidential primaries, many social issues with significant bioethics implications are also at stake in November’s election. Given the importance of science and health policy, it is worth exploring th...

The AMA’s recent apology to black physicians marks another moral milestone in white America’s ritualized confession of its racist past, standing alongside President Clinton’s 1997 apology to the survivors of the American government’s infamous syphilis study of black males. The AMA’s commiss...

Ever since HIPAA went into effect and I’ve been signing that form over and over at my doctors’ offices, attesting to my knowledge of the law, I’ve been feeling I should turn the tables and make my doctors and their staffs sign some form assuring me they know the limits of that law. The latest s...

As anti-miscegenation laws took hold in an effort to stop blacks and whites from marrying, by necessity courts had to start deciding who counted as white or black. The standard that ultimately emerged – namely the “one drop of blood” rule of blackness – dictated that any trace of black herita...