Jeremy R. Garrett

Collectivizing Rescue Obligations in Bioethics

Bioethicists invoke a duty to rescue in a wide range of cases. Indeed, arguably, there exists an entire medical paradigm whereby vast numbers of medical encounters are treated as rescue cases. The intuitive power of the rescue paradigm is considerable, but much of this power stems from the problematic way that rescue cases are conceptualized—namely, as random, unanticipated, unavoidable, interpersonal events for which context is irrelevant and beneficence is the paramount value. In this article, I critique the basic assumptions of the rescue paradigm, reframe the ethical landscape in which rescue obligations are understood, and defend the necessity and value of a wider social and institutional view. Along the way, I move back and forth between ethical theory and a concrete case where the duty to rescue has been problematically applied: the purported duty to regularly return incidental findings and individual research results in genomic and genetic research.

Marriage and the Well-Being of Children

Children’s well-being has become the focal consideration in legal and public policy debates regarding same-sex marriage. In this article, we critically examine and rebut the central moral argument made by opponents of same-sex marriage: that the state should not license any domestic arrangement other than “traditional marriage” because doing so would be detrimental to children’s well-being. Although many have challenged the empirical premise that children raised by same-sex couples fare worse than children in other arrangements, we focus primarily on the normative premises for exclusively licensing traditional (that is, monogamous, heterosexual) marriage. We argue that even if the empirical support for its claims was strong, the argument is morally insufficient for denying state recognition to other types of relationships. Importantly, we affirm the state’s vital role in promoting children’s well-being. We question, however, the approach of delegitimizing certain relationships as a means to that end. Instead, we argue, the state should encourage and support individuals who want to care for children, presume that any couple or individual is capable of adequate child-rearing, and ensure that all adults who are raising children (whether married or not) have the material resources and support necessary to be good parents. Such a policy would (1) set a reasonable minimal threshold for state recognition, (2) be vigilant in identifying cases falling below this threshold, and then (3) either assist or disqualify underperforming arrangements. It would also, appropriately, decouple arguments about legitimate and illegitimate types of relationships from arguments about what is best for children.

Beyond Harms and Benefits: Rethinking Duties to Disclose Misattributed Parentage

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.

Engaging pediatric health professionals in interactive online ethics education.

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 Childrens 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.

Why Are There So Few Ethics Consults in Children's Hospitals?

In most children’s hospitals, there are very few ethics consultations, even though there are many ethically complex cases. We hypothesize that the reason for this may be that hospitals develop different mechanisms to address ethical issues and that many of these mechanisms are closer in spirit to the goals of the pioneers of clinical ethics than is the mechanism of a formal ethics consultation. To show how this is true, we first review the history of collaboration between philosophers and physicians about clinical dilemmas. Then, as a case-study, we describe the different venues that have developed at one children’s hospital to address ethical issues. At our hospital, there are nine different venues in which ethical issues are regularly and explicitly addressed. They are (1) ethics committee meetings, (2) Nursing Ethics Forum, (3) ethics Brown Bag workshops, (4) PICU ethics rounds, (5) Grand Rounds, (6) NICU Comprehensive Care Rounds, (7) Palliative Care Team (PaCT) case conferences, (8) multidisciplinary consults in Fetal Health Center, and (9) ethics consultations. In our hospital, ethics consults account for only a tiny percentage of ethics discussions. We suspect that most hospitals have multiple and varied venues for ethics discussions. We hope this case study will stimulate research in other hospitals analyzing the various ways in which ethicists and ethics committees can build an ethical environment in hospitals. Such research might suggest that ethicists need to develop a different set of “core competencies” than the ones that are needed to do ethics consultations. Instead, they should focus on their skills in creating multiple “moral spaces” in which regular and ongoing discussion of ethical issues would take place. A successful ethicist would empower everyone in the hospital to speak up about the values that they believe are central to respectful, collaborative practice and patient care. Such a role is closer to what the first hospital philosophers set out to do than in the role of the typical hospital ethics consultant today.

Ethical issues in pediatric face transplantation

Facial transplantation has become a reality in adult medicine. Children are subject to congenital craniofacial differences, disease‐related, traumatic, or thermochemical craniofacial changes and might be suitable for face transplantation. This manuscript addresses unique ethical issues in considering potential pediatric face transplant. These challenges are operant at the individual, technologic, and psychosocial level for clinicians, investigators, and society.

The Poverty of Value Clarification: Using Ethical Theory to Critique and Transcend the “Givens” of Clinical Ethics Consultation

The Poverty of Value Clarification: Using Ethical Theory to Critique and Transcend the “Givens” of Clinical Ethics Consultation Jeremy R. Garrett To cite this article: Jeremy R. Garrett (2016) The Poverty of Value Clarification: Using Ethical Theory to Critique and Transcend the “Givens” of Clinical Ethics Consultation, The American Journal of Bioethics, 16:9, 48-51, DOI: 10.1080/15265161.2016.1196262 To link to this article: http://dx.doi.org/10.1080/15265161.2016.1196262

For Whom the Burden Tolls: Gender and the Unequal Management of Fetal Risks and Parental Expectations

For Whom the Burden Tolls: Gender and the Unequal Management of Fetal Risks and Parental Expectations Leslie Ann McNolty & Jeremy R. Garrett To cite this article: Leslie Ann McNolty & Jeremy R. Garrett (2016) For Whom the Burden Tolls: Gender and the Unequal Management of Fetal Risks and Parental Expectations, The American Journal of Bioethics, 16:2, 17-19, DOI: 10.1080/15265161.2015.1120811 To link to this article: https://doi.org/10.1080/15265161.2015.1120811

The Development of Bioethics in the United States: An Introduction

In the last four decades bioethics has experienced tremendous development, which can be attributed to various factors. First, advances in the biomedical sciences and biotechnology increasingly raise ethical, legal, and social issues that concern society at large. The complexity of the current health care system and the development of powerful biotechnologies necessitate the critical and interdisciplinary analysis that bioethics can provide. Second, the Joint Commission on Accreditation of Healthcare Organizations, which accredits health care organizations in the United States, requires hospitals to have a mechanism that offers clinical ethics consultations (Lo 2005, 111), and funding agencies expect the inclusion of bioethics components in research protocols. Finally, there is a need for bioethics education for health care professionals (physicians, nurses, chaplains, social workers, administrators, etc.) seeking advancement, IRB/Hospital Ethics Committee members working on health policies/ethics programs, and students seeking to include bioethics in their primary training or to pursue a career in bioethics.