Stephen Brown

Since publication of the “Ashley Case” in 2006, few rigorous clinical or research reports have elucidated the benefits, risks, outcomes, and experiences of children with severe neurodevelopmental disorders treated with Growth Attenuation Therapy (GAT). GAT remains available, however, with at least one institution publicly discussing its ongoing program. This paper describes ethics consultations provided for two separate GAT requests (hormonal treatment only) at one institution, both from parents who independently learned of the treatment elsewhere. We detail these comprehensive consultations, and subsequent multistakeholder deliberations undertaken to determine whether formal consultations should be required for similar future cases. We offer insights regarding processes for future potential candidates, including for addressing questions such as: Should all clinically similar children be offered GAT proactively or only upon parental request? What are the implications for access/equity? We call for further peer-reviewed scholarship to reanimate this historically stigmatized and understudied treatment.

There are certain traits that make us good human beings by enabling us to realize our natural ends. From the perspective of such a naturalized virtue ethics, there is nothing obviously unethical or imprudent about the capacity for same-sex love. Moreover, given the resources of this theory, such questions are empirical ones. If the capacity for same-sex love is a trait the possession of which makes one a good human being, then the just state will promote and encourage it, or at least not stand in its way. It can do so by allowing same-sex marriage.

Over the past several decades, medical ethics has gained a solid foothold in medical education and is now a required course in most medical schools. Although the field of medical ethics is by nature eclectic, moral philosophy has played a dominant role in defining both the content of what is taught and the methodology for reasoning about ethical dilemmas. Most educators largely rely on the case‐based method for teaching ethics, grounding the ethical reasoning in an amalgam of theories drawn from moral philosophy, including consequentialism, deontology, and principlism.In this article we hope to make a case for augmenting the focus of education in medical ethics. We propose complementing the traditional approach to medical ethics with a more embedded approach, one that has been described by others as “microethics,” the ethics of everyday clinical practice.

This article addresses whether cardiopulmonary resuscitation and sustained physiological support should ever be permitted in individuals who are diagnosed as brain dead and who had held previously expressed moral or religious objections to the currently accepted criteria for such a determination. It contrasts how requests for care would normally be treated in cases involving a brain-dead individual with previously expressed wishes to donate and a similarly diagnosed individual with previously expressed beliefs that did not conform to a brain-based conception of death. The paper first focuses narrowly on requests for CPR and then expands its scope to address extended physiological support. It describes how refusing the brain-dead non-donor's requests for either CPR or extended support would represent enduring harm to the antemortem or previously autonomous individual by negating their beliefs and self-identity. The paper subsequently discusses potential implications of policy that would allow greater accommodations to those with conscientious objections to currently accepted brain-based death criteria, such as for cost, insurance, higher brain formulations and bedside communication. The conclusion is that granting wider latitude to personal conceptions around the definition of death, rather than forcing a contested definition on those with valid moral and religious objections, would benefit both individuals and society.

Background While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians' attitudes about prenatal surgery for lethal and non-lethal conditions and to elucidate characteristics associated with these attitudes. Methods Survey of 1200 paediatric surgeons, neonatologists and maternal–fetal medicine specialists. Results Of 1176 eligible physicians, 670 responded. In the setting of a lethal condition for which prenatal surgery would likely result in the child surviving with a severe disability, most respondents either disagreed or strongly disagreed that they would recommend the surgery. Male physicians were twice as likely to recommend surgery for the lethal condition, as were physicians who believe that abortion is morally wrong. Older physicians were less likely to recommend surgery. For non-lethal conditions, most respondents agreed that they would recommend prenatal surgery, even if the surgery increases the risk of prematurity or fetal death. Compared with MFMs, surgeons were less likely to recommend such surgery, as were physicians not affiliated with a fetal centre, and physicians who were religious. Conclusion Physician’s attitudes about prenatal surgery relate to physicians’ beliefs about disability as well as demographic, cultural and religious characteristics. Given the variety of views, parents are likely to receive different recommendations from their doctors about the preferable treatment choice.

Background To determine whether fetal care paediatric and maternal–fetal medicine specialists harbour differing attitudes about pregnancy termination for congenital fetal conditions, their perceived responsibilities to pregnant women and fetuses, and the fetus as a patient and whether self-perceived primary responsibilities to fetuses and women and views about the fetus as a patient are associated with attitudes about clinical care.Methods Mail survey of 434 MFM and FCP specialists.Results MFMs were more likely than FCPs to disagree with these statements : ‘the presence of a fetal abnormality is not an appropriate reason for a couple to consider pregnancy termination’ ; ‘the effects that a child born with disabilities might have on marital and family relationships is not an appropriate reason for a couple to consider pregnancy termination’ ; and ‘the cost of healthcare for the future child is not an appropriate reason for a couple to consider pregnancy termination’. 65% MFMs versus 47% FCPs disagreed that their professional responsibility is to focus primarily on fetal well-being. Specialists did not differ regarding the fetus as a separate patient. Responses about self-perceived responsibility to focus on fetal well-being were associated with clinical practice attitudes.Conclusions Independent of demographic and sociopolitical characteristics, FCPs and MFMs possess divergent ethical sensitivities regarding pregnancy termination, pregnant women and fetuses, which may influence clinical care.

The proponent of the epistemological gap maintains that value claims are justified in a different way than are nonvalue claims. I show that a neo-Aristotelian naturalized virtue ethics does not fall prey to this gap. There are ethical claims concerning human beings that are epistemically justified in a way logically identical to the way in which are justified certain nonethical claims about human and nonhuman organisms. This demonstration (1) lends credibility to naturalized virtue ethics, (2) calls into question the very notion of an epistemological gap, and (3) confronts antinaturalists with a dilemma.