Report
The Hastings Center
FROM THE EDITOR
VOLUME 44, NO. 1 • JANUARY-FEBRUARY 2014
Thinking about Thinking
Gregory E. Kaebnick Editor
his issue of the Report has four focal points. First, going in order of appearance, if one is the front-to-back kind of reader, is a collection of commentaries on the public health policies of Michael Bloomberg, who as of this writing is closing out his stint as mayor of New York. Bloomberg’s contribution to public health was the subject of a recent essay in the Report by Lawrence Gostin, and the commentaries are responses to his essay. Second is a set of essays written by physicians who, thinking about medicine from a point nearer the end than the beginning of a career, offer some reflections on the values that guided the care they rendered to patients and the interactions they had with patients and their families about medical decisions. In a way, they are considering what bioethics came to mean to them. The essays collected here came together entirely by happenstance—none were solicited. That doesn’t exactly make them random data points, but it does make for an interesting convergence, with all the weight of, well, happenstance. In one way or another, the authors all express misgivings about the values that seem to have been formally handed down to them and look instead to values that they discover in their relationships with patients. Third is the lead article and two accompanying commentaries. The article, by Lynn Jansen, who teaches ethics at Oregon Health and Science University, proposes an innovative explanation for why the subjects of medical research often seem to have great difficulty accurately gauging whether the research will be medically beneficial for them. Subjects may have different “mindsets” about the research at different points in their involvement with it, Jansen suggests. The first commentary lauds the paper and examines its implications in greater detail; the second lauds the effort to rethink subjects’ capacities for assessing the therapeutic benefit of research but raises questions about the research on “mindsets.” The physicians’ essays are about how the physicians thought about values. Jansen’s paper is about how subjects think about the research they’re in. The nature of thought is also the subject of the fourth thematic cluster, which is a special report, published as a supplement to the issue, on the uses of stories in bioethics. The report is a kind of update on the field of narrative ethics: essays contributed by some of the scholars who have been prominent in narrative ethics try to articulate why and how thinking in terms of stories can be valuable in the midst of a clinical bioethics consultation, what kinds of considerations come to the fore when we think in terms of stories, and whether there are limits to or concerns about the use of stories. A fuller explanation of what the special report accomplishes and how the pieces in it work together is to be found in the report’s foreword, which amounts to another editor’s note, one focusing on the content of the report and written by the report’s guest editor, Martha Montello. Professor Montello approached us with the idea for this report in early 2013 and gets the lion’s share of the credit for it: functioning as an issue or volume editor, she took the lead in outlining its shape and structure, identifying authors, soliciting the essays, and working with the authors to craft the essays and meet the deadlines. The Report’s internal editorial staff was involved from the periphery, by vetting the proposal, providing advice during the project’s development, and finally taking the editor’s red pen to the essays at the end. As with other special reports published here as supplements, the credit we can take is very limited. Mostly we’re to be congratulated for keeping good company. —GEKn
Laura Haupt Managing Editor
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2 HASTIN G S C E N T E R R E P ORT
Susan Gilbert Stephen R. Latham Contributing Editors Nora Porter Art Director Nancy Berlinger Michael K. Gusmano Josephine Johnston 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., 350 Main St., Malden, MA 02148-5020. Contents copyright © 2014 by The Hastings Center. All rights reserved. January-February 2014
The Hastings Center
FROM THE EDITOR
VOLUME 44, NO. 1 • JANUARY-FEBRUARY 2014
Thinking about Thinking
Gregory E. Kaebnick Editor
his issue of the Report has four focal points. First, going in order of appearance, if one is the front-to-back kind of reader, is a collection of commentaries on the public health policies of Michael Bloomberg, who as of this writing is closing out his stint as mayor of New York. Bloomberg’s contribution to public health was the subject of a recent essay in the Report by Lawrence Gostin, and the commentaries are responses to his essay. Second is a set of essays written by physicians who, thinking about medicine from a point nearer the end than the beginning of a career, offer some reflections on the values that guided the care they rendered to patients and the interactions they had with patients and their families about medical decisions. In a way, they are considering what bioethics came to mean to them. The essays collected here came together entirely by happenstance—none were solicited. That doesn’t exactly make them random data points, but it does make for an interesting convergence, with all the weight of, well, happenstance. In one way or another, the authors all express misgivings about the values that seem to have been formally handed down to them and look instead to values that they discover in their relationships with patients. Third is the lead article and two accompanying commentaries. The article, by Lynn Jansen, who teaches ethics at Oregon Health and Science University, proposes an innovative explanation for why the subjects of medical research often seem to have great difficulty accurately gauging whether the research will be medically beneficial for them. Subjects may have different “mindsets” about the research at different points in their involvement with it, Jansen suggests. The first commentary lauds the paper and examines its implications in greater detail; the second lauds the effort to rethink subjects’ capacities for assessing the therapeutic benefit of research but raises questions about the research on “mindsets.” The physicians’ essays are about how the physicians thought about values. Jansen’s paper is about how subjects think about the research they’re in. The nature of thought is also the subject of the fourth thematic cluster, which is a special report, published as a supplement to the issue, on the uses of stories in bioethics. The report is a kind of update on the field of narrative ethics: essays contributed by some of the scholars who have been prominent in narrative ethics try to articulate why and how thinking in terms of stories can be valuable in the midst of a clinical bioethics consultation, what kinds of considerations come to the fore when we think in terms of stories, and whether there are limits to or concerns about the use of stories. A fuller explanation of what the special report accomplishes and how the pieces in it work together is to be found in the report’s foreword, which amounts to another editor’s note, one focusing on the content of the report and written by the report’s guest editor, Martha Montello. Professor Montello approached us with the idea for this report in early 2013 and gets the lion’s share of the credit for it: functioning as an issue or volume editor, she took the lead in outlining its shape and structure, identifying authors, soliciting the essays, and working with the authors to craft the essays and meet the deadlines. The Report’s internal editorial staff was involved from the periphery, by vetting the proposal, providing advice during the project’s development, and finally taking the editor’s red pen to the essays at the end. As with other special reports published here as supplements, the credit we can take is very limited. Mostly we’re to be congratulated for keeping good company. —GEKn
Laura Haupt Managing Editor
T
2 HASTIN G S C E N T E R R E P ORT
Susan Gilbert Stephen R. Latham Contributing Editors Nora Porter Art Director Nancy Berlinger Michael K. Gusmano Josephine Johnston 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., 350 Main St., Malden, MA 02148-5020. Contents copyright © 2014 by The Hastings Center. All rights reserved. January-February 2014
