Abe Schwab

The human microbiome is the bacteria, viruses, and fungi that cover our skin, line our intestines, and flourish in our body cavities. Work on the human microbiome is new, but it is quickly becoming a leading area of biomedical research. What scientists are learning about humans and our microbiomes could change medical practice by introducing new treatment modalities. This new knowledge redefines us as superorganisms comprised of the human body and the collection of microbes that inhabit it and reveals how much we are a part of our environment. The understanding that microbes are not only beneficial but sometimes necessary for survival recasts our interaction with microbes from adversarial to neighborly. This volume explores some of the science that makes human microbiome research possible. It then considers ethical, legal, and social concerns raised by microbiome research. Chapters explore issues related to personal identity, property rights, and privacy. The authors reflect on how human microbiome research challenges reigning views on public health and research ethics. They also address the need for thoughtful policies and procedures to guide the use of the biobanked human samples required for advancing this new domain of research. In the course of these explorations, they introduce examples from the history of biomedical science and recent legal cases that shed light on the issues and inform the policy recommendations they offer at the end of each topic's discussion.This volume is the product of an NIH Human Microbiome Project grant. It represents three years of conversations focused on consensus formation by the twenty-seven members of the interdisciplinary Microbiome Working Group.

From the beginning, a code of ethics for bioethicists has been conceived of as part of a movement to professionalise the field. In advocating for such a code, Baker repeatedly identifies 'having a code of ethics' with 'professionalization'. The American Society of Bioethics and Humanities echoes this view in their code of ethics for healthcare ethics consultants 1 and the subsequent publication in the American Journal of Bioethics.2 Taking for granted that a code of ethics could be a valuable asset for HCECs, this essay has two aims. First, there are good reasons to doubt that the label 'profession' has significant meaning for HCECs. Attempts to accurately conceive of a profession fall into two broad camps: substantive and formal. Substantive conceptions should be rejected. Specifically, substantive conceptions beg the question about what it means to be a profession, which produces devastating problems for practical application. Formal conceptions of profession avoid begging the question, but do so at the cost of identifying the responsibilities of a profession. Using the term 'professional responsibilities', then, requires additional explication and classifying HCECs as professionals requires the identification of their role-specific responsibilities.i Second, this essay will critique the ASBH code of ethics for HCECs as a first articulation of these responsibilities. As written, this code of ethics has limited value for HCECs because most of the responsibilities identified in this code do not identify HCEC-specific responsibilities. In closing, some important strategies to improve upon this initial attempt to define the responsibilities of HCECs are identified.

Gawande’s fourth popular book, Being Mortal, layers touching story after touching story into a devastating critique of how people approach the end of life. At times, keeping all the narratives straight proves difficult, yet each piece of each narrative remains powerful. These accounts are woven neatly together with personal and professional reflection as well as scholarship. For example, in the midst of telling readers about his grandmother-in-law's approach to the end of life, surgeon/journalist Gawande quotes B. Vladeck, summing up the origins of one problematic approach: “describing the history of nursing homes from the perspective of the elderly ‘is like describing the opening of the American West from the perspective of the mules’”. As Being Mortal draws to a close, Gawande offers some recommendations for improving how people face the end of life. Though he does not break new ground here, he rightly points out and announces human shortcomings in a way that all can see and understand. Summing Up: Highly recommended. All levels/libraries.

This volume is the fourth book by Madell. One might understand this as a belated follow-up to his earlier book on the self. The text sits squarely in the analytic tradition of philosophy with its abstract argumentation. Madell’s focus centers on making sense of both the objective characteristics of lived experiences and the narrowly personal experience of individual existence. His treatment of this issue is situated within the rich literature on the topic, which provides a valuable backdrop for readers. His discussion of this literature, however, presumes familiarity with the constellation of positions. That is, though a few examples from the existing scholarship receive extended treatment, many examples and positions are only briefly referenced. Readers unfamiliar with the existing scholarship will be left to search out these arguments and positions before they can appreciate the extent of the argument. Accordingly, those unfamiliar with the scholarship will find the book close to impenetrable. Summing Up: Recommended. With reservations. Graduate students, researchers, and faculty.

This 80-page, spiral bound manual designed by the American College of Surgeons Division of Education as a companion publication to Ethical Issues in Clinical Surgery for Instructors and Practicing Surgeons. This case-based manual helps residents examine the ethical underpinnings of clinical practice and address the ethics issues and questions they face everyday while caring for patients. Each chapter includes realistic surgery-based cases, questions for discussion, bioethics bottom line sections, learning objectives, suggested readings, a glossary, and additional resources. Special margins designed for note-taking add to the utility of the manual. Topics addressed include a framework for considering ethical issues in clinical surgery, competition of interests, truth telling and the surgeon-patient relationship, confidentiality, professional obligations of surgeons, end-of-life issues, and substitute decision making.

Choosing a health care plan that is both ethically sound and financially prudent is one of the biggest challenges facing businesses today. Many people think that high-quality, compassionate health care plans are prohibitively expensive. But in reality, purely cost-driven decisions end up costing businesses more in the long run. Fair health care coverage decisions are actually good for business! Studies show that employees who see their benefits as fair are more likely to stay with their employer, be more productive, and refrain from legal action. Fairness is the best policy - but employers are uncertain how to reconcile doing what is right with doing what is cost-effective. "Ensuring Fairness in Health Care Coverage" provides employers with a solid ethical framework for making even the most challenging benefits decisions. Based on a study by the Ethical Force Program, led by the Institute for Ethics at the American Medical Association, this book enables employers to make difficult decisions about the fairness - and perceived fairness - of the health benefits they provide, such as: whether to provide benefits to domestic partners; whether to give lower coverage for mental than for physical illnesses; whether to charge employees who smoke or who are obese more for health care coverage; how to differentiate between the various types of health care coverage - from HMOs to Health Savings Accounts - and how to determine which will benefit the most employees; and whether to index employee contributions to their salaries, with higher-paid employees paying more for the same benefits. This groundbreaking book provides five ethical guideposts to help employers make such decisions. The guideposts were developed by the Ethical Force Program's extensive interviews with a national expert advisory board representing the perspectives of all major participants in the health care system, including employers, insurance companies, physicians, patients, and regulators, followed by focus groups to further refine the principles. As this book explains, fair decision making should be: transparent - being completely open and honest about what decisions are made and why; Participatory - including employees in the decision process Sensitive to value - providing coverage that is both efficient and effective; Consistent - avoiding favoritism; and Compassionate - offering flexibility for special circumstances. Authors Matthew Wynia and Abraham Schwab show how to apply these guideposts to practical dilemmas employers face every day. Using real-world examples from their extensive research, they bring the principles to life and provide concrete steps for taking action on sensitive and complex issues. Their analyses of case examples, showing how employers have dealt with specific problems, are particularly enlightening. Creative and compassionate, "Ensuring Fairness in Health Care Coverage" will help employers design and administer plans for the benefit of their employees and their businesses.

This volume follows up a previous work by Zimmerman,Living with Uncertainty, and continues his investigation of the metaethics of uncertainty. This installment centers on defending his favored view of moral obligation from various criticisms he has encountered since first articulating it. Ignorance and Moral Obligationincludes several clarifications of the prospective view, including repeated emphasis on "projected" rather than "expected" outcomes. As a straight philosophy text, this book will be useful for faculty and graduate students who read the previous book and found it interesting. It will be less useful for those unfamiliar with Living with Uncertainty or those interested in an attempt to address uncertainty from anywhere other than metaethics. For example, the distinction between "projected" and "expected" outcomes would be familiar to economists and other decision theorists; however, this literature goes unmentioned. Moreover, one of Zimmerman’s repeated cases deals with "testimony" as a social epistemic source; discussion of this literature is also left aside. As a metaethical defense of Zimmerman's view, this volume seems to work. As a contribution to an interdisciplinary understanding of one's moral responsibilities, more work remains.

Ender’s Game, Orson Scott Card’s award-winning 1985 novel, has been discovered and rediscovered by generations of science fiction fans, even being adopted as reading by the U.S. Marine Corps.Ender's Game and its sequels explore rich themes — the violence and cruelty of children, the role of empathy in war, and the balance of individual dignity and the social good — with compelling elements of a coming-of-age story. Ender’s Game and Philosophy brings together over 30 philosophers to engage in wide-ranging discussion on issues such as: the justifiability of pre-emptive strikes; how Ender’s disconnected and dispassionate violence is mirrored in today’s drone warfare; whether the end of saving the species can justify the most brutal means; the justifiability of lies and deception in wartime, and how military schools produce training in virtue. The authors of Ender’s Game and Philosophychallenge readers to confront the challenges that Ender’s Game presents, bringing new insights to the idea of a just war, the virtues of the soldier, the nature of childhood, and the serious work of playing games.

Mounting evidence indicates that the practice patterns of physicians may be improved by an increased attention to social science. As such, the general features of the arguments in Sales and Schlaff’s article “Reforming Medical Education: A review and synthesis of five critiques of medical practice” in this issue of Social Science & Medicine are easy to endorse. It seems, however, that the applications of social science are needed more urgently in the structure of medical practice than they are in the activities of particular physicians. In what follows, I expand on this point through a discussion of two dogmas of empirical training in medicine: the dominance of physical sciences and the legitimacy of intuitive judgment.

Using four examples of cost-effectiveness analyses, I argue that discussions of and research on cost-effectiveness in medical practice should clearly delineate between protocol and practice cost-effectiveness analyses. Failure to do so risks confusing conclusions that warrant substantial confidence and limited applicability with conclusions with broader applicability but more limited confidence. Further, these different types of analyses incorporate different sets of values. I argue that some favor should be shown for those analyses that include a wider array of values