Hope and Resentment.

A common challenge for both health-care providers and policymakers is to deal with people as people, rather than merely as biological or social problems to be managed. In terms introduced in P. F. Strawson's much-discussed essay "Freedom and Resentment" (1962), the difficulty is to maintain a reactive "participant stance," rather than a solely objective perspective, toward those with whom they have difficulties. Vaccine resistance and refusal provides a particularly pointed instance of this challenge: there is evidence that suggests standard methods of rational persuasion tend to be ineffective, even counter-productive, in easing skepticism about the safety, effectiveness, or appropriateness of vaccines and vaccine regimens. If clear and vivid information about relative risks is not compelling, the temptation to manipulate rather than convince skeptics may be hard, or even seem wrong, to resist. Mark Navin's recent Values and Vaccine Refusal (2016) can be read as a reminder of the importance-and the difficulty-of maintaining a participant stance toward vaccine deniers or resisters.

How We Become Who We Are: Ashley, Carla, and the Rest of Us.

Lisa Freitag and Joan Liaschenko's thoughtful and important article goes directly to the under-examined heart of Ashley's case, namely to what sustains her in a habitable and intelligible identity. Though quite sympathetic with their conclusion and line of argument, I try to trouble their proceedings a bit, largely by wondering how having a specific such identity, out of several that may be in-principle available, matters to someone with Ashley's cognitive scope. I do this not simply to be contrary, but because their article also seems to me to raise issues in the ethics of bioethics-in particular, what I call the dilemma of ethical endeavor: How ought one publicly pursue deeply important and complex issues, the very raising of which may offend interlocutors who indeed have grounds for resentment. Making a habit of second guessing oneself may be part of the answer.

Knowing About Others: On 'The Role of Relational Knowing in Advance Care Planning'.

Kate Robins-Browne and her colleagues have written a conceptually daring, empirically grounded article that is rich in scholarship and just conceivably might have a salutary effect on the theory and practice of advance care planning. It is, alas, just as easy to believe that its appreciation will be restricted to like-minded theorists. Writing from a posture of great admiration for this article's agenda and achievements, I will consider why non-relationally-based understanding of deciding for others are so enduring, and what might be done about that.

Where families and healthcare meet.

Recent developments in professional healthcare pose moral problems that standard bioethics cannot even identify as problems, but that are fully visible when redefined as problems in the ethics of families. Here, we add to the growing body of work that began in the 1990 s by demonstrating the need for a distinctive ethics of families. First, we discuss what 'family' means and why families can matter so deeply to the lives of those within them. Then, we briefly sketch how, according to an ethics of families, responsibilities must be negotiated against the backdrop of family relationships, treatment decisions must be made in the light of these negotiated responsibilities and justice must be served, both between families and society more generally and within families themselves.

Medicine and making sense of queer lives.

As practiced, medicine bumps along with the rest of us, doing its level best to cope with the contingencies of this often heartbreaking world. Yet it's a commonplace that much of medicine's self-image, and a good deal of its cultural heft, come from its connection with the natural sciences and, what's more, from a picture of science that has a touch of the transcendental, highlighting the unmatched rigor of its procedures, its exacting rationality, and the reliability of its results. In contrast, the very idea of "queer" carries with it a little taste of the uncanny. What we're inclined to label queer resists understanding, not so much because it's too complicated, but because it tends to be too slippery to capture neatly in our conceptual nets-that queer ache in your side, for instance, or your partner's queer notion of doing laundry. The outmoded use of "queer," as a way to refer disparagingly to gay people, carried similar uncanny connotations: the unnatural, the perverse. One might think, then, that the reclamation of "queer" as an umbrella term referring to the lesbian, gay, bisexual, and transgender spectrum has a pleasing depth to its irony-not only does it wrench the customary direction of evaluation conveyed by the word from condemnation to celebration, but it also hints that what you find comprehensible depends a good deal on who you are and where you're standing. What from the perspective of many heterosexual and cisgendered people may seem opaque, exotic, threatening-erotic love directed toward someone with the same kind of body you have, lives lived in ways that challenge the immutability of birth-assigned gender-are to LGBT folk not uncanny at all, but as familiar as breathing. I like this conceit, but alas, it is too simple. It slights the variety of difficulties associated with making sense of queerness that can vex deeply thoughtful people of undoubted good will-as I found out some years ago when I first talked about my efforts to understand my own transgender identity with a ferociously intelligent, highly sophisticated friend.

Strengths and opportunities to clinical trial enrollment among BIPOC, rural dwelling patients in the northwest United States: a retrospective study.

Introduction: Clinical trials investigating the safety and efficacy of experimental drugs and devices are the cornerstone of medicinal advancement. Enrolling sufficient participants in these trials is vital to ensure adequate statistical power and generalizability. Clinical trial participation is particularly low among certain populations, including medically underserved communities (i.e., rural areas) and Black, Indigenous, and People of Color (BIPOC). Methods: A retrospective study design was used to understand patient outcomes and access/barriers to clinical trial participation in the rural northwest United States. A quantitatively focused retrospective chart review was conducted for adult participants enrolled in at least one clinical trial in a single northwest health system between 1999 and 2022. Descriptive and inferential statistical analyses were performed to assess trial outcomes at a significance level 0.05. Results: The retrospective chart review yielded 833 clinical trial records with 753 individual enrolled participants. The all-cause relative frequency of death at last known follow-up amongst clinical trial participants was 8.90% (n = 67). Based on logistic regression, the death was significantly associated with the participants' age at initial trial screening (ß = 0.09, p-value <0.001), those that resided in non-metro areas (ß = -0.86, p-value = 0.045), and those that lived in Northeastern Montana (ß = 1.27, p-value = 0.025). Additionally, death at last known follow-up was significantly associated with enrollment in 2021-2022 (ß = -1.52, p-value <0.001), enrolled in more than one study (ß = 0.84, p-value = 0.023), in internationally sponsored trials (ß = -2.08, p-value <0.001), in Phase I (ß = 5.34, p-value <0.001), in Phase II trials (ß = 1.37, p-value = 0.013), diabetes as a primary trial target (ß = -2.04, p-value = 0.003). Conclusion: As decentralized trial design and remote or virtual elements of traditional trials become normative, representation of rural and frontier populations is imperative to support the generalizability of trial data encouraged by the FDA.

Doubt, Disorientation, and Death in the Plague Time.

An account of an experience with contracting an illness that may well have been Covid-19 gives rise to reflections on doubt and on the art of dying well. The upshot: our mortality remains a fundamentally disorienting condition of our existence. If there's any wisdom to be had concerning our deaths, it likely lies in the direction of accepting their deranging character, rather than in searching for the philosophical insight that will reconcile us to our fate.

Understanding Transgender and Medically Assisted Gender Transition: Feminism as a Critical Resource.

Feminism has fought the trivialization of women's experiences, championed women's security, and insisted on respect for women's choices. In so doing, feminism has developed important perspectives on the complicated connections between what gender means as it plays itself in people's lives, and the inequalities of power and authority that structure much of human experience. Here, I put a few of these perspectives into contact with an issue where the interactions of gender and power are squarely in play: medicine's role in assisting gender transitioning generally and, specifically, the enduring controversy between medicine and many transgender people about the pathologization of transgender and the role of clinicians as gatekeepers to gender-transition interventions.

Lavender (Lavandula angustifolia Miller).

An evidence-based systematic review including scientific evidence, expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.