Jeremy Garrett

In this issue of the Hastings Center Report, Amulya Mandava, Joseph Millum, and Benjamin E. Berkman revisit an old conundrum—whether to disclose incidental findings of misattributed parentage—in light of new developments in genomic sequencing that will make that conundrum both more complex and more common. While the authors’ defense of nondisclosure as the appropriate default action in genomic research aligns with prior thinking and practice, their exploration of philosophical foundations is refreshingly rigorous and developed. The final product of their analysis—an applied taxonomy of the types of harms and benefits that can result from disclosure of misattributed parentage—is an important contribution to the literature on this subject and worthy of serious consideration by genomic researchers and bioethicists alike. Despite these virtues, I am struck by the authors’ deference to the traditional assumption that disclosure ethics can be adequately understood and appreciated within a purely consequentialist framework.

abstract It is generally assumed that the link between utilitarianism and vegetarianism is relatively straightforward. However, a familiar objection to utility‐based vegetarianism maintains that, given the massive scale of animal agribusiness, any given person is causally impotent in reducing the overall number of animals raised for food and, thus, in reducing the unfathomably high quantity of disutility engendered thereby. Utilitarians have frequently responded to this objection in two ways: first, by appealing to expected utility and economic thresholds, and, secondly, by appealing to publicity effects. In this paper, I will offer some reasons for thinking that, however far these responses go in the direction of ethical vegetarianism, both leave an important normative gap between the dietary prescription they are capable of underwriting and a ‘minimally‐genuine’ vegetarian obligation. What is needed to close this gap is a utility‐based reason that (1) generates an ethical prescription for minimally‐genuine vegetarianism and (2) circumvents the causal impotence objection. As I see it, there is a straightforward and auspicious reason that can perform both of the required tasks — namely, an appeal to the well‐documented welfare‐reducing effects of eating animal products upon human health. For, if causal impotence is to work as a global objection to utility‐based vegetarianism (rather than as a more local objection to certain reasons supporting that position), then it must operate as a general thesis about the incapacity for any given individual to bring about more utility solely through her own abstention from consuming animal products. However, for almost any given individual, the decision to maintain a vegetarian diet is causally potent in at least diminishing the expected disutility for herself of poorer health and a shorter life span associated with the consumption of animal products. Thus, it follows that (1) there are plausible, if not conclusive, utilitarian grounds for minimally‐genuine vegetarianism and (2) the causal impotence objection fails as a general criticism of utility‐based vegetarianism.

In 1970, President Richard Nixon expressed his unambiguous support for interracial marriage; as for same-sex marriage, he exclaimed, "I can't go that far—that's the year 2000" . Nixon's prescient remark, made shortly after the Supreme Court's 1967 decision in Loving v. Virginia to overturn anti-miscegenation laws, expresses at once hesitancy for, yet resigned acceptance of, the inevitable expansion of civil marriage to include more and more kinds of loving partnerships. Nearly forty years later, Nixon's uncanny prediction appears close to being realized. At the very least, many have gone where he claimed to be unable to go, adding their voices to a growing movement seeking state recognition of same-sex unions as a matter of equality, rights, and justice. And, indeed, a strong case might be made on such grounds, were the state justified in sponsoring an institution of civil marriage in the first place

Bioethical decision‐making in pediatrics diverges from similar decisions in other medical domains because the young child is not an autonomous decision‐maker, while the teen is developing—and should be encouraged to develop—autonomy and decisional capacity. Thus the balance between autonomy and beneficence is fundamentally different in pediatrics than in adult medicine. While ethical dilemmas that reflect these fundamental issues are common, many pediatric physician and nursing training programs do not delve into the issues or offer specific training about how to deal with borderline cases.To meet this need, the Children's Mercy Bioethics Center in Kansas City, Missouri, created a program specifically dedicated to serving practicing, experienced pediatric health professionals. Our students come from various professional disciplines: they are doctors, nurses, social workers, chaplains, lawyers, psychologists, counselors, and hospital administrators practicing in pediatrics.

Many bioethicists view the primary task of bioethics as ‘value clarification’. In this article, I argue that the field must embrace two more ambitious agendas that go beyond mere clarification. The first agenda, critique, involves unmasking, interrogating, and challenging the presuppositions that underlie bioethical discourse. These largely unarticulated premises establish the boundaries within which problems can be conceptualized and solutions can be imagined. The function of critique, then, is not merely to clarify these premises but to challenge them and the boundaries they define. The second agenda, integration, involves honoring and unifying what is right in competing values. Integration is the morally ideal response to value conflict, offering the potential for transcending win/lose outcomes. The function of integration, then, is to envision actions or policies that not only resolve conflicts, but that do so by jointly realizing many genuine values in deep and compelling ways. My argument proceeds in stages. After critically examining the role and dominant status of value clarification in bioethical discourse, I describe the nature and value of the two agendas, identify concrete examples of where each has been and could be successful, and explain why a critical integrative bioethics – one that appreciates the joint necessity and symbiotic potential of the two agendas – is crucial to the future of the field. The ultimate goal of all of this is to offer a more compelling vision for how bioethics might conduct itself within the larger intellectual and social world it seeks to understand and serve