Report
The Hastings Center
FROM THE EDITOR
VOLUME 45, NO. 2 • March-April 2015
Looking at It Wrong
T
he articles in this issue of the Hastings Center Report push the traditional boundaries of bioethics, but in radically different directions. As the lead, we have chosen an article by Jonathan Kimmelman and Alex John London that offers a new understanding of clinical translation—the process, that is, of generating clinical tools from the theoretical understanding of disease developed in the laboratory. As Kimmelman and London point out, clinical translation is widely held to be in trouble. In general, the feeling is that there’s been lots of basic science on disease mechanisms over the last twenty years or so, but there’s only a trickle of good new medications in the “drug pipeline.” Kimmelman and London’s claim, crudely put, is that we’re looking at it wrong; clinical translation can stand improvement, but not for the reasons and not in the ways often suggested. Clinical translation is not best thought of as a “pipeline” at all, they argue, nor is it primarily about drugs. It’s really about information—“information about the coordinated set of materials, practices, and constraints needed to safely unlock the therapeutic or preventive activities of drugs, biologics, and diagnostics.” And developing that information is not a oneway, pipeline-like flow from laboratory through trials to the clinic; rather, trials and clinical practice feed back into the basic theoretical understandings. The overall flow of information looks more like a web than a pipeline. In a second article, John Hardwig asks us to look at pregnancy in a different direction. Hardwig is the author of one of the Report’s more frequently mentioned articles, “Is There a Duty to Die?,” and in this issue he continues in that same surprising and maybe even contrarian vein by asking, in effect, whether there can ever be a duty to have an abortion. He argues that fatherhood, like motherhood, is an enormous undertaking and should never be imposed; if a man accidentally participates in producing a pregnancy, then he should be able to decline fatherhood, just as the woman should be able to decline motherhood. Nor is it possible for a man simply to wash his hands of responsibility for his child, if the child comes into the world. The parent-child relationship doesn’t really work like that, and to say that the man can simply walk away is to say—very wrongly, in Hardwig’s view—that childrearing is women’s work. Elsewhere in this issue are two pieces that take opposite sides on the language of rationing. In one of the essays, Peter Ubel explains why he has given up on the word “rationing” even though he still defends policies that could be described as rationing. In a book review, Jon Tilburt explores Phillip Rosoff ’s argument for why we should retain “rationing.” (And in the Perspective column, Hastings’s own Susan Gilbert discusses the emergence of online portals that aim to help consumers investigate the value of medical services on their own.) This issue also contains another installment in the series of essays on teaching bioethics that were selected last year by Millie Solomon, president of The Hastings Center, and Lisa Lee, executive director of the Presidential Commission for the Study of Bioethical Issues, with input from a panel of other reviewers. The last couple of issues have featured essays that described methods of educating health care practitioners in pediatric settings. In this issue, Autumn Fiester considers the training of clinical ethics consultants and explains her strategy for helping trainees to think about clinical ethics cases in a way that is respectful of diverse values and religious positions. —GEKn
2 HASTIN G S C E N T E R R E P ORT
Gregory E. Kaebnick Editor Laura Haupt Managing Editor Susan Gilbert Stephen R. Latham Contributing Editors Nora Porter Art Director Nancy Berlinger Michael K. Gusmano Erik Parens Editorial Committee The Hastings Center Report (ISSN 0093-0334 print; ISSN 1552-146X online) is published bimonthly on behalf of The Hastings Center by Wiley Subscription Services, Inc., a Wiley Company, 111 River St., Hoboken, NJ 07030-5774. The Hastings Center, an independent, nonpartisan, nonprofit organization, addresses fundamental ethical issues in the areas of health, medicine, and the environment as they affect individuals, communities, and societies. For more information on the Center’s interdisciplinary research and education programs, visit its website at www.thehastingscenter.org. The Hastings Center Report is sent to individual and institutional subscribers. For ordering information, claims, and any inquiry concerning your journal subscription, please go to http:// www.wileycustomerhelp.com/ask or contact your nearest office. Americas: [email protected] or 1-800-8356770. Europe, Middle East, and Africa: [email protected]; +44 (0)-1865778315. Asia Pacific: cs-journals@wiley. com or +65-6511-8000. Periodicals postage paid at Hoboken, NJ, and additional mailing offices. postmaster: Send all address changes to the Hastings Center Report, Journal Customer Services, John Wiley and Sons, Inc., c/o The Sheridan Press, PO Box 465, Hanover, PA 17331. Contents copyright © 2015 by The Hastings Center. All rights reserved.
March-April 2015
The Hastings Center
FROM THE EDITOR
VOLUME 45, NO. 2 • March-April 2015
Looking at It Wrong
T
he articles in this issue of the Hastings Center Report push the traditional boundaries of bioethics, but in radically different directions. As the lead, we have chosen an article by Jonathan Kimmelman and Alex John London that offers a new understanding of clinical translation—the process, that is, of generating clinical tools from the theoretical understanding of disease developed in the laboratory. As Kimmelman and London point out, clinical translation is widely held to be in trouble. In general, the feeling is that there’s been lots of basic science on disease mechanisms over the last twenty years or so, but there’s only a trickle of good new medications in the “drug pipeline.” Kimmelman and London’s claim, crudely put, is that we’re looking at it wrong; clinical translation can stand improvement, but not for the reasons and not in the ways often suggested. Clinical translation is not best thought of as a “pipeline” at all, they argue, nor is it primarily about drugs. It’s really about information—“information about the coordinated set of materials, practices, and constraints needed to safely unlock the therapeutic or preventive activities of drugs, biologics, and diagnostics.” And developing that information is not a oneway, pipeline-like flow from laboratory through trials to the clinic; rather, trials and clinical practice feed back into the basic theoretical understandings. The overall flow of information looks more like a web than a pipeline. In a second article, John Hardwig asks us to look at pregnancy in a different direction. Hardwig is the author of one of the Report’s more frequently mentioned articles, “Is There a Duty to Die?,” and in this issue he continues in that same surprising and maybe even contrarian vein by asking, in effect, whether there can ever be a duty to have an abortion. He argues that fatherhood, like motherhood, is an enormous undertaking and should never be imposed; if a man accidentally participates in producing a pregnancy, then he should be able to decline fatherhood, just as the woman should be able to decline motherhood. Nor is it possible for a man simply to wash his hands of responsibility for his child, if the child comes into the world. The parent-child relationship doesn’t really work like that, and to say that the man can simply walk away is to say—very wrongly, in Hardwig’s view—that childrearing is women’s work. Elsewhere in this issue are two pieces that take opposite sides on the language of rationing. In one of the essays, Peter Ubel explains why he has given up on the word “rationing” even though he still defends policies that could be described as rationing. In a book review, Jon Tilburt explores Phillip Rosoff ’s argument for why we should retain “rationing.” (And in the Perspective column, Hastings’s own Susan Gilbert discusses the emergence of online portals that aim to help consumers investigate the value of medical services on their own.) This issue also contains another installment in the series of essays on teaching bioethics that were selected last year by Millie Solomon, president of The Hastings Center, and Lisa Lee, executive director of the Presidential Commission for the Study of Bioethical Issues, with input from a panel of other reviewers. The last couple of issues have featured essays that described methods of educating health care practitioners in pediatric settings. In this issue, Autumn Fiester considers the training of clinical ethics consultants and explains her strategy for helping trainees to think about clinical ethics cases in a way that is respectful of diverse values and religious positions. —GEKn
2 HASTIN G S C E N T E R R E P ORT
Gregory E. Kaebnick Editor Laura Haupt Managing Editor Susan Gilbert Stephen R. Latham Contributing Editors Nora Porter Art Director Nancy Berlinger Michael K. Gusmano Erik Parens Editorial Committee The Hastings Center Report (ISSN 0093-0334 print; ISSN 1552-146X online) is published bimonthly on behalf of The Hastings Center by Wiley Subscription Services, Inc., a Wiley Company, 111 River St., Hoboken, NJ 07030-5774. The Hastings Center, an independent, nonpartisan, nonprofit organization, addresses fundamental ethical issues in the areas of health, medicine, and the environment as they affect individuals, communities, and societies. For more information on the Center’s interdisciplinary research and education programs, visit its website at www.thehastingscenter.org. The Hastings Center Report is sent to individual and institutional subscribers. For ordering information, claims, and any inquiry concerning your journal subscription, please go to http:// www.wileycustomerhelp.com/ask or contact your nearest office. Americas: [email protected] or 1-800-8356770. Europe, Middle East, and Africa: [email protected]; +44 (0)-1865778315. Asia Pacific: cs-journals@wiley. com or +65-6511-8000. Periodicals postage paid at Hoboken, NJ, and additional mailing offices. postmaster: Send all address changes to the Hastings Center Report, Journal Customer Services, John Wiley and Sons, Inc., c/o The Sheridan Press, PO Box 465, Hanover, PA 17331. Contents copyright © 2015 by The Hastings Center. All rights reserved.
March-April 2015
