Responding Effectively to Disruptive Patient Behaviors: Beyond Behavior Contracts.

This Viewpoint discusses the use of behavior contracts with patients in response to increasing workplace violence in health care, and highlights the importance of building the evidence base for approaches to dealing with violent behaviors that are effective and just.

Entities, Uncertainties, and Behavioral Indicators of Consciousness.

Two problems related to the identification of consciousness are the distribution problem-or how and among which entities consciousness is distributed in the world-and the moral status problem-or which species, entities, and individuals have moral status. The use of inferences from neurobiological and behavioral evidence, and their confounds, for identifying consciousness in nontypically functioning humans, nonhuman animals, and artificial intelligence is considered in light of significant scientific uncertainty and ethical biases, with implications for both problems. Methodological, epistemic, and ethical consensus are needed for responsible consciousness science under epistemic and ethical uncertainty. Consideration of inductive risk is proposed as a potential tool for managing both epistemic and ethical risks in consciousness science.

How One Health Instrumentalizes Nonhuman Animals.

This article interrogates anthropocentrism and nonhuman animal instrumentalization in One Health (OH). It argues that OH's approach to human health and zoonosis focuses too narrowly on furthering certain human interests at the expense of nonhuman animals, which is not sustainable, just, or compassionate. This article also offers an alternative vision for protecting and promoting health for all over the long term that includes the human right to self-determination and the nonhuman animal right to not be exploited or abused. This rights-based approach recognizes that the root causes of zoonosis should be identified and addressed via policies and actions that challenge nonhuman animal exploitation.

Existing Ethical Tensions in Xenotransplantation.

The genetic modification of pigs as a source of transplantable organs is one of several possible solutions to the chronic organ shortage. This paper describes existing ethical tensions in xenotransplantation (XTx) that argue against pursuing it. Recommendations for lifelong infectious disease surveillance and notification of close contacts of recipients are in tension with the rights of human research subjects. Parental/guardian consent for pediatric xenograft recipients is in tension with a child's right to an open future. Individual consent to transplant is in tension with public health threats that include zoonotic diseases. XTx amplifies concerns about justice in organ transplantation and could exacerbate existing inequities. The prevention of infectious disease in source animals is in tension with the best practices of animal care and animal welfare, requiring isolation, ethologically inappropriate housing, and invasive reproductive procedures that would severely impact the well-being of intelligent social creatures like pigs.

Educational interventions and animal consumption: Results from lab and field studies.

Currently, there are many advocacy interventions aimed at reducing animal consumption. We report results from a lab (N = 267) and a field experiment (N = 208) exploring whether, and to what extent, some of those educational interventions are effective at shifting attitudes and behavior related to animal consumption. In the lab experiment, participants were randomly assigned to read a philosophical ethics paper, watch an animal advocacy video, read an advocacy pamphlet, or watch a control video. In the field experiment, we measured the impact of college classes with animal ethics content versus college classes without animal ethics content. Using a pretest, post-test matched control group design, humane educational interventions generally made people more knowledgeable about animals used as food and reduced justifications and speciesist attitudes supporting animal consumption. None of the interventions in either experiment had a direct, measurable impact on self-reported animal consumption. These results suggest that while some educational interventions can change beliefs and attitudes about animal consumption, those same interventions have small impacts on animal consumption.

Toward an Anti-Maleficent Research Agenda.

Important advances in biomedical and behavioral research ethics have occurred over the past few decades, many of them centered on identifying and eliminating significant harms to human subjects of research. Comprehensive attention has not been paid to the totality of harms experienced by animal subjects, although scientific and moral progress require explicit appraisal of these harms. Science is a public good and the prioritizing within, conduct of, generation of, and application of research must soundly address questions about which research is morally defensible and valuable enough to support through funding, publication, tenure, and promotion. Likewise, educational pathways of re-imagined science are critical.

Shifting the Moral Burden: Expanding Moral Status and Moral Agency.

Two problems are considered here. One relates to who has moral status, and the other relates to who has moral responsibility. The criteria for mattering morally have long been disputed, and many humans and nonhuman animals have been considered "marginal cases," on the contested edges of moral considerability and concern. The marginalization of humans and other species is frequently the pretext for denying their rights, including the rights to health care, to reproductive freedom, and to bodily autonomy. There is broad agreement across cultural and philosophical traditions about the capacities and responsibilities of moral agents. I propose an inclusive and expansive way of thinking about moral status, situating it not in the characteristics or capacities of individuals, but in the responsibilities and obligations of moral agents. Moral agents, under this view, are not privileged or entitled to special treatment but rather have responsibilities. I approach this by considering some African communitarian conceptions of moral status and moral agency. I propose that moral agency can also be more expansive and include not just individual moral agents but collective entities that have some of the traits of moral agents: power, freedom, and the capacity to recognize and act on the demands of morality and acknowledge and respect the rights of others. Expanding who and what is a moral agent correspondingly extends moral responsibility for respecting rights and fostering the conditions for the health and wellbeing of humans and animals onto the collective entities who uniquely have the capacity to attend to global-scale health threats such as pandemics and human-caused climate change.

The Road Not Mapped: The Neuroethics Roadmap on Research with Nonhuman Primates.

We have arrived at an inflection point, a moment in history when the sentience, consciousness, intelligence, agency, and even the moral agency of many nonhuman animals can no longer be questioned without ignoring centuries of accumulated scientific knowledge. Nowhere is this more true than in our understanding of nonhuman primates (NHPs). A neuroethics committed to probing the ethical implications of brain research must be able to respond to and anticipate the challenges ahead as brain projects globally prepare to increase the use of NHPs in research. This requires adopting a less anthropocentric focus that includes nonhuman animals within its scope. But the Neuroethics Roadmap represents a missed opportunity to critically examine the future direction of research with NHPs in an ethically-responsive neuroscience.

A Belmont Report for Animals?

Human and animal research both operate within established standards. In the United States, criticism of the human research environment and recorded abuses of human research subjects served as the impetus for the establishment of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, and the resulting Belmont Report. The Belmont Report established key ethical principles to which human research should adhere: respect for autonomy, obligations to beneficence and justice, and special protections for vulnerable individuals and populations. While current guidelines appropriately aim to protect the individual interests of human participants in research, no similar, comprehensive, and principled effort has addressed the use of (nonhuman) animals in research. Although published policies regarding animal research provide relevant regulatory guidance, the lack of a fundamental effort to explore the ethical issues and principles that should guide decisions about the potential use of animals in research has led to unclear and disparate policies. Here, we explore how the ethical principles outlined in the Belmont Report could be applied consistently to animals. We describe how concepts such as respect for autonomy and obligations to beneficence and justice could be applied to animals, as well as how animals are entitled to special protections as a result of their vulnerability.

The NIH BRAIN Initiative: Integrating Neuroethics and Neuroscience.

The NIH Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative is focused on developing new tools and neurotechnologies to transform our understanding of the brain, and neuroethics is an essential component of this research effort. Coordination with other brain projects around the world will help maximize success.

Death by neurological criteria: expert definitions and lay misgivings.

For decades, there has been persistent controversy concerning brain death, or the determination of death by neurological criteria, among physicians, philosophers, and the lay public. This article examines the various ways that brain death is conceptualized and justified, as well as the persistent questions and controversies related to brain death, particularly within pluralistic, multicultural societies. A culturally sensitive and practical way forward is proposed.

The Case for Reasonable Accommodation of Conscientious Objections to Declarations of Brain Death.

Since its inception in 1968, the concept of whole-brain death has been contentious, and four decades on, controversy concerning the validity and coherence of whole-brain death continues unabated. Although whole-brain death is legally recognized and medically entrenched in the United States and elsewhere, there is reasonable disagreement among physicians, philosophers, and the public concerning whether brain death is really equivalent to death as it has been traditionally understood. A handful of states have acknowledged this plurality of viewpoints and enacted "conscience clauses" that require "reasonable accommodation" of religious and moral objections to the determination of death by neurological criteria. This paper argues for the universal adoption of "reasonable accommodation" policies using the New Jersey statute as a model, in light of both the ongoing controversy and the recent case of Jahi McMath, a child whose family raised religious objections to a declaration of brain death. Public policies that accommodate reasonable, divergent viewpoints concerning death provide a practical and compassionate way to resolve those conflicts that are the most urgent, painful, and difficult to reconcile.