Franklin Miller

Bioethics has been an interdisciplinary field since its inception. From the founding of the Hastings Center in 1969 and the Kennedy Institute of Ethics in 1971, scholars from many disciplines have come together to create a field of study strengthened by its interdisciplinarity. In this special issue of Perspectives in Biology and Medicine, we celebrate the interdisciplinary character of bioethics by means of essays by eight distinguished bioethics scholars hailing from backgrounds in philosophy, law, medicine, nursing, public health, history, sociology, and narrative methods. Each contributor offers a personal perspective on their journey into bioethics from a particular disciplinary background...

Given the long‐standing controversy about whether the brain‐dead should be considered alive in an irreversible coma or dead despite displaying apparent signs of life, the ethical and policy issues posed when family members insist on continued treatment are not as simple as commentators have claimed. In this article, we consider the kind of policy that should be adopted to manage a family's insistence that their brain‐dead loved one continues to receive supportive care. We argue that while it would be ethically inappropriate to continue to devote scarce acute care resources to such patients in a hospital setting, it may not be ethically inappropriate for patients to receive these resources in certain other settings. Thus, if a family insists on continuing to care for their brain‐dead loved at their home, we should not, from a policy perspective, interfere with the family's wishes. We also argue that healthcare professionals should make some effort to facilitate the transfer of brain‐dead patients to these other settings when families insist on continued treatment despite being informed about the lack of any potential for recovery of consciousness. Our arguments are strengthened by the fact that patients in a persistent vegetative state, who, when correctly diagnosed, also have no potential for recovery of consciousness, are routinely transferred from hospitals to nursing homes or long‐term care facilities where they continue to be ventilated, tube fed and to receive other supportive care. We also briefly explore the question of who should be responsible for the costs of such treatment at the long‐term care facility.

Something has changed in America with respect to facing death. As I write this review of When Breath Becomes Air by Paul Kalanithi, it is number one on the New York Times nonfiction bestseller's list; number 10 is Being Mortal by Atul Gawande, on the list for 62 weeks. A few years ago, Christopher Hitchens's Mortality, a remarkable narrative of his living in the face of dying from esophageal cancer, also was a bestseller. While denial of death was thought to be an American characteristic, this may be true no longer; or at least the public shows a strong interest in narratives about mortality.To what extent does the appetite of the reading public signify a changed perspective on mortality?...

I came to bioethics scholarship in 1990 at age 42. My first two published papers were solo-authored. But subsequently most of my bioethics research, including 223 articles and 22 book chapters written with many coauthors, has been collaborative; and my one monograph book, Death, Dying, and Organ Transplantation, was a collaborative venture with Robert Truog. As my academic field is philosophy, where collaborative work is rare, I had no background for doing this. I lacked any formal mentorship in bioethics and thus had no training in doing collaborative research.Looking back, I see three motivations for doing collaborative research and writing in bioethics. First, I began teaching bioethics as an adjunct faculty...

The placebo effect, in recent years, has been the focus of extensive scientific inquiry and public fascination, as reflected in articles in the news media. Authors writing about placebo effects often mention the goal of harnessing the placebo effect for the benefit of patients in clinical practice. This suggests that the placebo effect is like a powerful horse, which needs to be put in harness in order to do useful work. However, developing an accurate understanding of what has been labelled, often misleadingly, as the "placebo effect" and taking advantage of this phenomenon have been hampered by the conceptual muddle surrounding this topic. To continue the equine metaphor...

In the research ethics literature, there is strong disagreement about the ethical acceptability of placebo-controlled trials, particularly when a tested therapy aims to alleviate a condition for which standard treatment exists. Recently, this disagreement has given rise to debate over the moral appropriateness of the principle of clinical equipoise for medical research. Underlying these debates are two fundamentally different visions of the moral obligations that investigators owe their subjects.Some commentators and ethics documents claim that physicians, whether acting as care givers or researchers, have the same duty of beneficence towards their patients and subjects: namely, that they must provide optimal medical care. In discussing placebo surgery in research on refractory Parkinson's disease, Peter Clark succinctly states this view: “The researcher has an ethical responsibility to act in the best interest of subjects.”

In lieu of an abstract, here is a brief excerpt of the content:Introduction to the Special SectionFranklin G. MillerHappy is a female elephant who has been confined at the Bronx Zoo for over 40 years. In 2018 the Nonhuman Rights Project sued the Wildlife Conservation Society, which manages the zoo, seeking habeas corpus for Happy in order to release her to an elephant sanctuary. Numerous amicus curiae briefs were filed in favor and against the petition on behalf of Happy. The case reached the highest court in New York State, which denied the petition of the plaintiff in June 2022.This special section includes views on the case of Happy by David DeGrazia, Martha Nussbaum, and Christine Korsgaard, three distinguished moral philosophers who have made significant contributions to animal ethics. The essays by Martha Nussbaum and Christine Korsgaard are drawn from the amicus briefs that they filed in the legal proceedings, which they agreed could be published here.Professor Nussbaum applies her "capabilities approach" as a foundation for promoting wellbeing and recognizing rights to Happy and to elephants in general. She argues that Happy is a being with a meaningful life and is entitled to be treated with respect and dignity, which is incompatible with her conditions of confinement at the zoo. Professor Korsgaard applies her understanding of the moral philosophy of Immanuel Kant to the case of Happy—a "cognitively sophisticated [End Page 1] animal" which, like human beings, should be treated as an end in herself and not merely as a means to the purposes of human beings. Professor DeGrazia, in an invited essay, analyzes the meanings of "person" and examines the pertinent characteristics of elephants that make them at least "borderline persons," with the moral status of possessing basic rights.While Happy remains confined at the Bronx Zoo, these three incisive contributions challenge readers to reflect on the ethical treatment of nonhuman animals, especially those with complex and rich capacities of intelligence and emotion. [End Page 2]Franklin G. MillerWeill Cornell Medical College, New YorkCopyright © 2023 Johns Hopkins University Press...

In this essay I offer practical guidance aimed at promoting competence and success in the activity of bioethics scholarship. I present a set of maxims or rules of thumb, which I exemplify and explicate by drawing on my own work, encompassing 30 years of practicing bioethics scholarship, formal and informal mentoring, extensive peer reviewing for bioethics, biomedical, and philosophy journals, and several years as Deputy Editor of Perspectives in Biology and Medicine—an interdisciplinary journal that frequently publishes bioethics articles. The title of the essay is adapted from Max Weber’s famous lecture, “Science as a Vocation”.Bioethics scholarship generally takes two forms:...

Elderly individuals are at higher risk of serious illness and death if they become infected by the coronavirus. During the current pandemic, my wife and I, at ages seventy‐two and seventy‐one, respectively, have been paying a person laid off from a job to purchase groceries—a practice that exposes the shopper to risk of infection for our benefit. In this essay, I examine this practice with respect to the normative concepts of treating another person as a means, coercion, exploitation, and complicity.

Hospice is the premiere end of life program in the United States, but its requirement that patients forgo disease-directed therapies and that they have a prognosis of 6 months or less means that it serves less than half of dying patients and often for very short periods of time. Palliative care offers careful attention to pain and symptom management, added support for patients and families, and assistance with difficult medical decision making alongside any and all desired medical treatments, but it does not include a comprehensive system of care as is provided by hospice. The practice of palliative care and hospice is filled with sometimes overt (requests for hastened death in an environment where such acts are legally prohibited) and other times covert (the delay in palliative care referral because the health care team believes it will undermine disease directed treatment) ethical issues. The contributors to this volume use a series of case presentations within each chapter to illustrate some of the palliative care and hospice challenges with significant ethical dimensions across the three overarching domains: 1) care delivery systems; 2) addressing the many dimensions of suffering; and 3) difficult decisions near the end of life. The contributors are among the most experienced palliative care, hospice and ethics scholars in North America and Western Europe. Each has been given relatively free reign to address what they feel are the most pressing ethical challenges within their domain, so a wide range of positions and vantage points are represented. As a result, the volume provides a very diverse ethical exploration of this relatively young field that can deepen, stretch, and at times confront any simple notion of the challenges facing patients, their families, professional caregivers, and policy makers.

The Belmont Report begins with the sentence, “It is important to distinguish between biomedical and behavioral research, on the one hand, and the practice of accepted therapy on the other”. Writing an essay in a journal issue devoted to the 40th anniversary of the Belmont Report offers an opportunity not only to examine critically a theme addressed in this remarkable document—the distinction between research and practice—but also to reflect on the role of this theme as a major dimension of my work as a bioethics scholar. Encompassing only 12 pages of text, the Belmont Report is a seminal and rich examination of basic norms defining the ethics of biomedical research. I have read the...

On June 16, 1966, the New England Journal of Medicine published “Ethics and Clinical Research” by Henry K. Beecher. Beecher’s account of 22 examples of unethical contemporary clinical research shook up the medical profession and helped pave the way for U.S. federal regulation of research involving human subjects. Five decades later, in this issue of Perspectives in Biology and Medicine, we pay tribute to the lasting significance of this whistle-blowing article and to the remarkable contributions of Henry Beecher. Beecher was a pioneer in anesthesiology as an academic discipline and in research on pain and the placebo effect. He was an early and influential champion of randomized placebo-controlled...

Der folgende Artikel ist im Jahr 2003 unter dem Titel „Clinical Pragmatism: A Method of Moral Problem Solving“ in dem Sammelband „Pragmatic bioethics“ erschienen, welcher sich mit der Bedeutung der pragmatistischen Philosophie für die Praxis befasst. In dem vom Internisten und Bioethiker Joseph J. Fins, dem Thoraxchirurgen Matthew D. Bacchetta und dem Philosophen und Medizinethiker Franklin G. Miller verfassten Beitrag wird der pragmatistische Ansatz in der klinischen Ethik anhand eines Fallbeispiels gleichzeitig beschrieben, begründet und demonstriert. Obgleich die Denkrichtung der pragmatistischen Philosophie sowohl wissenschaftstheoretisch wie praktisch hoch bedeutsam ist – ohne diese ist weder die heutige sozialwissenschaftliche Forschung noch die angewandte, insbesondere die klinische Ethik denkbar –, werden pragmatistische Ansätze im deutschsprachigen Raum bis heute eher rudimentär rezipiert.