Jake Earl

Background Making clinical ethics consultation (CEC) services available to patients and their family members is a best practice most hospitals in the United States claim to follow. However, patients and families often lack awareness of CEC and rarely request CEC services. One reason patients and families might underutilize CEC is they lack access to important information about hospitals’ CEC services.Methods Since patients and families often use hospital websites to find information about services, we applied a standardized search protocol to characterize information about CEC services hospitals have published on their own websites or websites of their academic affiliates. Our sample included the top 100 general, adult hospitals in the US identified by Newsweek and Statista in their 2024 ranking of hospitals around the world.Results We found 88 hospitals (88%) had information on their websites indicating availability of CEC services, with 79 (79%) indicating patients and families may request those services. Hospitals with websites indicating availability of CEC services often provided information about how to request CEC (77.3%), how CEC might benefit requesters (69.3%), and a specific phone number for making requests (58%). Other types of potentially important information appeared less often on the hospitals’ websites, such as the names of people who provide CEC (27.3%), an email address for requesting CEC (20.5%), and whether and how the hospital charges for CEC (19.3%).Conclusions This study reveals both needed improvements and potential models of best practice related to providing information about CEC services for patients and families on the websites of leading hospitals in the United States. US hospitals have an opportunity to promote accessibility of CEC by improving the quality of information about CEC services on their websites.

Horizon scanning is intended to identify opportunities and threats associated with technology, regulatory, and social change. Here, we report the results of a new horizon scan based on inputs of an international group of 33 participants, focusing on future issues arising from the military use of artificial intelligence (AI) for augmenting human performance. The final list of 12 issues includes topics spanning from the political (educating and training individuals to accept and work with AI), to the regulatory (issues of consent to human-AI teaming and hybridization), to security (the hackability of neural devices that connect to AI), to philosophical (the nature and phenomenology of brain-to-brain interfaces). The early identification of such issues is relevant to researchers, policymakers, military practitioners, and the wider public.

Horizon scanning is intended to identify opportunities and threats associated with technology, regulatory, and social change. Here, we report the results of a new horizon scan based on inputs of an international group of 33 participants, focusing on future issues arising from the military use of artificial intelligence (AI) for augmenting human performance. The final list of 12 issues includes topics spanning from the political (educating and training individuals to accept and work with AI), to the regulatory (issues of consent to human-AI teaming and hybridization), to security (the hackability of neural devices that connect to AI), to philosophical (the nature and phenomenology of brain-to-brain interfaces). The early identification of such issues is relevant to researchers, policymakers, military practitioners, and the wider public.

Horizon scanning is intended to identify opportunities and threats associated with technology, regulatory, and social change. Here, we report the results of a new horizon scan based on inputs of an international group of 33 participants, focusing on future issues arising from the military use of artificial intelligence (AI) for augmenting human performance. The final list of 12 issues includes topics spanning from the political (educating and training individuals to accept and work with AI), to the regulatory (issues of consent to human-AI teaming and hybridization), to security (the hackability of neural devices that connect to AI), to philosophical (the nature and phenomenology of brain-to-brain interfaces). The early identification of such issues is relevant to researchers, policymakers, military practitioners, and the wider public.

Clinical researchers should help respect the autonomy and promote the well-being of prospective study participants by helping them make voluntary, informed decisions about enrollment. However, participants often exhibit poor understanding of important information about clinical research. Bioethicists have given special attention to “misconceptions” about clinical research that can compromise participants’ decision-making, most notably the “therapeutic misconception.” These misconceptions typically involve false beliefs about a study’s purpose, or risks or potential benefits for participants. In this article, we describe a misconception involving false beliefs about a study’s potential benefits for non-participants, or its expected social value. This social value misconception can compromise altruistically motivated participants’ decision-making, potentially threatening their autonomy and well-being. We show how the social value misconception raises ethical concerns for inherently low-value research, hyped research, and even ordinary research, and advocate for empirical and normative work to help understand and counteract this misconception’s potential negative impacts on participants.

The COVID-19 pandemic forced us to reconsider our interactions with the world around us, shifting how we navigate public and private spaces every day. Most people in the United States previously thought nothing of touching railings or doorknobs, going to school or work while ill, or attending crowded events. Along with new health interventions and institutional practices, daily behaviors aimed at infection control, such as routine hand washing and wearing face masks when symptomatic, protected our communities from COVID-19. Many new interventions and practices are here to stay, but it is unclear which personal behaviors to protect against COVID-19 and other infectious diseases we should continue. Intuitively plausible ethical arguments support individuals taking reasonable measures to avoid causing or propagating harm to other members of the community. As such, by failing to adopt easily implementable preventive behaviors, we live ethically suboptimal lives and violate our social contract to one another. As the world transitions from epidemic to endemic COVID-19, applying the lessons learned from the pandemic is crucial to mitigating old and new infectious disease threats. Along with the role of public health agencies to organize and communicate about communicable diseases, clinicians and public health workers have critical roles in establishing social norms for behaviors that prevent the spread of infectious diseases, given their professional responsibilities and statuses as trusted authority figures.

The Food and Drug Administration (FDA) recently issued its first approval of an oral contraceptive medication for access without a clinician’s prescription. One might expect this will lead to fewer people seeking to terminate unplanned pregnancies, including in states that imposed severe restrictions on abortion care following the Supreme Court’s reversal on abortion rights in Dobbs v. Jackson Women’s Health Organization. Despite the clear potential health benefits, increased accessibility of oral contraceptives offers no real solution to ongoing threats to patients’ reproductive health and moral rights created by post-Dobbs abortion restrictions. To secure their patients’ reproductive health and well-being, clinicians must work to maximize the benefits of OTC oral contraceptives without relenting in their advocacy for safe and accessible abortion care.

The case (Dawson et al. 2024) describes an Institutional Review Board (IRB) chair who seeks consultation about waiving the requirement that investigators obtain prospective, informed consent for collection of microbiome samples by swabbing the perianal region of severely burned patients shortly after their admission to an intensive care unit (ICU). We argue that it is ethically permissible to waive informed consent requirements for the perianal swab and that the IRB should approve a waiver as permitted by regulations.

The case describes researchers who are seeking ethics guidance on communicating with participants in a phase-1 COVD-19 vaccine trial about FDA-authorized COVID-19 vaccines (Wilfond, Duenas, and Johnson 2023). The researchers want help choosing among three options they have identified for encouraging participants to obtain one of the authorized vaccines. We argue that research ethics consultants should consider going beyond this question to address another ethics concern the researchers might have overlooked.

Although researchers generally take great care to ensure that human subjects do not suffer very serious harms from their involvement in research, the situation is different for nonhuman animal subjects. Significant progress has been made in reducing unnecessary animal suffering in research, yet researchers still inflict severe pain and distress on tens of thousands of animals every year for scientific purposes. Some bioethicists, scientists, and animal welfare advocates argue for placing an upper limit on the suffering researchers may impose on animal subjects, with rare exceptions for research that promises critical social benefits. In this article, I argue against such an upper limit on harm on the grounds that researchers often can compensate animal subjects for their suffering, even severe and long-lasting suffering. If animal subjects receive adequate compensation for the harms they suffer, then there is no general limit on how much suffering researchers may impose on them for scientific purposes.

Innovative practice involves medical interventions that deviate from standard practice in significant ways. For many patients, innovative practice offers the best chance of successful treatment. Because little is known about most innovative treatments, clinicians who engage in innovative practice might consider including extra procedures, such as scans or blood draws, to gather information about the innovation. Such information-gathering interventions can yield valuable information for modifying the innovation to benefit future patients and for designing scientific studies of the innovation. However, existing guidelines do not say when or whether it is appropriate to add potentially risky information-gathering interventions for these purposes. As a result, clinicians may assume that information-gathering interventions are ethically inappropriate and should not be used in innovative practice. This assumption can lead to seriously negative consequences, such as increasing the likelihood that harmful or ineffective innovations will be adopted and creating new barriers to the development of genuinely beneficial treatments. We argue that health care institutions need to promote the responsible use of information-gathering interventions as an adjunct to innovative practice, and that these interventions are not clinical research and should not be subject to research oversight.

Many contemporary ethical debates turn on claims about the nature and extent of our alleged procreative moral rights: moral rights to procreate or not to procreate as we choose. In this article, I argue that there are no procreative moral rights, in that generally we do not have a distinctive moral right to procreate or not to procreate as we choose. However, interference with our procreative choices usually violates our nonprocreative moral rights, such as our moral rights to bodily autonomy or to privacy. My argument presents hypothetical cases in which a state interferes with a person's procreative choices in order to promote aggregate social welfare, but this interference does not violate any of the person's nonprocreative moral rights. These cases not only undermine frequently made claims that widely recognized nonprocreative moral rights entail procreative moral rights, they also challenge the intuitively plausible claim that interference with our procreative choices as such violates our moral rights. What at first appear to be substantive moral rights are in fact a kind of illusion created by the frequent overlap of other rights, but lacking in substance beyond that overlap. While this argument against the existence of procreative moral rights has substantive implications for ongoing debates in reproductive ethics, I ultimately suggest that it is consistent with a progressive approach to reproductive justice.

Eyal et al have recently argued that researchers should consider conducting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) human challenge studies to hasten vaccine development. We have conducted (J. L.) and overseen (L. D.) human challenge studies and agree that they can be useful in developing anti-infective agents. We also agree that adults can autonomously choose to undergo risks with no prospect of direct benefit to themselves. However, we disagree that SARS-CoV-2 challenge studies are ethically appropriate at this time, for 3 reasons: (1) current scientific knowledge of SARS-CoV-2 infection is insufficient to manage risks; (2) autonomous decision making, while necessary, does not override concerns about risk; and (3) undertaking challenge studies now would imperil confidence in the research enterprise, potentially undermining the global response to the coronavirus disease 2019 (COVID-19) pandemic.

One of the Belmont Report’s most important contributions was the clear and serviceable distinction it drew between standard medical practice and biomedical research. A less well-known achievement of the Report was its conceptualization of innovative practice, a type of medical practice that is often mistaken for research because it is new, untested, or experimental. Although the discussion of innovative practice in Belmont is brief and somewhat cryptic, this does not reflect the significant progress its authors made in understanding innovative practice and the distinctive ethical issues it raises. This article explores the history and broader context of Belmont’s conception of innovative practice, its strengths and weaknesses, and its contemporary relevance for scholars working in bioethics and health policy. While this conception of innovative practice deserves our attention, it is inherently limited in some important ways.

The Routledge Handbook of the Philosophy of Childhood and Children is an impressive collection of original essays on conceptual and normative issues related to the first (post-natal) phases of human life. As co-editor Anca Gheaus notes in her introduction to the collection, philosophers’ historical inattention to these issues is “puzzling”, given the importance of childhood and children for both individual and societal flourishing (p. 1). Attentive readers will be even more puzzled by this fact, given the variety of interesting, challenging questions raised by the collection’s 44 contributors. It is even more striking that despite the size and scope of the collection, most of its essays are introductory in nature, primarily orienting readers to ongoing philosophical debates or noting topics for future investigation. The very existence of such a collection makes a strong case that the philosophy of childhood and children is and will continue to be a worthwhile endeavor.

Innovative practice occurs when a clinician provides something new, untested, or nonstandard to a patient in the course of clinical care, rather than as part of a research study. Commentators have noted that patients engaged in innovative practice are at significant risk of suffering harm, exploitation, or autonomy violations. By creating a pathway for harmful or nonbeneficial interventions to spread within medical practice without being subjected to rigorous scientific evaluation, innovative practice poses similar risks to the wider community of patients and society as a whole. Given these concerns, how should we control and oversee innovative practice, and in particular, how should we coordinate innovative practice and clinical research? In this article, I argue that an ethical approach to overseeing innovative practice must encourage the early transition to rigorous clinical research without delaying or deferring the development of beneficial innovations or violating the autonomy rights of clinicians and their patients.

Several philosophers have recently argued that policies aimed at reducing human fertility are a practical and morally justifiable way to mitigate the risk of dangerous climate change. There is a powerful objection to such “population engineering” proposals: even if drastic fertility reductions are needed to prevent dangerous climate change, implementing those reductions would wreak havoc on the global economy, which would seriously undermine international antipoverty efforts. In this article, we articulate this economic objection to population engineering and show how it fails. We argue, first, that the economic objection paints an inaccurate picture of the complicated relationship between demographic change and economic growth, and second, that any untoward economic effects of fertility reduction can be mitigated with additional policies. Specifically, we argue that supplementing fertility reduction with policies that facilitate the emigration of younger people from developing nations to developed nations could allow for both global reductions in GHG emissions and continued economic stability. Further, we show that moral arguments against such unprecedented increases in immigration are unsuccessful. We conclude that population engineering is a practical and morally justifiable tool for addressing the twin evils of climate change and global poverty.

Contrary to political and philosophical consensus, we argue that the threats posed by climate change justify population engineering, the intentional manipulation of the size and structure of human populations. Specifically, we defend three types of policies aimed at reducing fertility rates: choice enhancement, preference adjustment, and incentivization. While few object to the first type of policy, the latter two are generally rejected because of their potential for coercion or morally objectionable manipulation. We argue that forms of each policy type are pragmatically and morally justified tools for preventing the harms of global climate change.

The Procreation Asymmetry holds that we have strong moral reasons not to create miserable people for their own sakes, but no moral reasons to create happy people for their own sakes. To defend this conjunction against an argument that it leads to inconsistency, I show how recognizing ‘creation’ as a temporally extended process allows us to revise the conjuncts in a way that preserves their intuitive force. This defense of the Procreation Asymmetry is preferable to others because it does not require us to take on controversial metaphysical or metaethical commitments – in other words, it has the theoretical virtue of portability.