Choosing to Die.

Two articles in the September-October 2022 issue of the Hastings Center Report discuss health-related reasons that people might have to actively bring their lives to an end. In one, Brent Kious considers the situation of a person who, because of illness, becomes a burden on loved ones. A person in such a situation might prefer to die, and Kious argues that, while there is no obligation to hasten one's death, the choice to do so could sometimes be reasonable. In a second article, Henri Wijsbek and Thomas Nys discuss a case in the Netherlands in which a woman with severe dementia was euthanized at a point when her advance euthanasia directive did not align with what she said, when asked, about death. Wijsbek and Nys defend the authority of her advance directive against a range of objections. In a third article, Henry Silverman and Patrick Odonkor, physicians at the University of Maryland Medical Center, where the first pig-to-human heart transplantation was performed in early 2022, develop recommendations for clinical trials of porcine heart transplantation. And an essay in the issue criticizes the allocation recommendations developed for Covid-19 vaccines by the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices.

Justice, Bioethics, and Covid-19.

Both articles in the November-December 2021 issue of the Hastings Center Report reflect bioethics' growing interest in questions of justice, or more generally, questions of how collective interests constrain individual interests. Hugh Desmond argues that human enhancement should be reconsidered in light of developments in the field of human evolution. Contemporary understandings in this area lead, he argues, to a new way of thinking about the ethics of enhancement-an approach that replaces personal autonomy with group benefit as the primary criterion for deciding what enhancements are acceptable. In the second article, Johannes Kniess considers the many attempts within bioethics to draw on John Rawls's work to discuss health care access and social determinants of health, and he comes across as moderately optimistic that Rawls's theory of justice has ongoing relevance.

The Crisis in Standards of Care.

Since the start of the Covid-19 pandemic, debates have waged about "crisis standards of care" ("CSC")-the guidelines for the allocation of resources if those resources are too scarce to meet the needs of all patients. The Hastings Center Report's September-October 2021 issue features a collection of pieces on this debate. In the lead article, MaryKatherine Gaurke and colleagues object to the idea that the allocation of scarce resources should aim to save the most "life-years," arguing instead that the objective should be to save the most lives. Gaurke et al. assert that it is only theorists who have favored the life-years strategy; the public has not-or at least, there is no good evidence that the public has. This claim is elaborated in the article by Alex Rajczi and colleagues, who argue that identifying and applying the public's will-a process they call "political reasoning"-is the core work in developing CSC. Five commentaries-two coauthored, by Douglas B. White and Bernardo Lo and by Anuj B. Mehta and Matthew K. Wynia, and three solo authored, by Govind Persad, Virginia A. Brown, and Robert D. Truog-offer further arguments about and insights into CSC.

Heart and Soul.

The lead article in this January-February 2021 issue-the first of the Hastings Center Report's fiftieth year of publication-does not set out to change medicine. It tries instead to understand it. In "A Heart without Life: Artificial Organs and the Lived Body," Mary Jean Walker draws on work in phenomenology and on empirical research with people who have received artificial heart devices to argue that such devices may have two very different effects on how a patient experiences the body and the self. Several other pieces in this issue address the ongoing slew of patient care and health policy problems surrounding the Covid-19 pandemic, and a special report titled Democracy in Crisis: Civic Learning and the Reconstruction of Common Purpose considers the requirements for public involvement in policy-making about bioethical issues.

Learning from a Pandemic.

The Covid-19 pandemic has highlighted connections between health and social structural phenomena that have long been recognized in bioethics but have never really been front and center-not just access to health care, but fundamental conditions of living that affect public health, from income inequality to political and environmental conditions. In March, as the pandemic spread globally, the field's traditional focus on health care and health policy, medical research, and biotechnology no longer seemed enough. The adequacy of bioethics seemed even less certain after the killing of George Floyd, whose homicide showed in an especially agonizing way how social institutions are in effect (and often intentionally) designed to make the lives of black people go poorly and end early. Whether bioethics needs to be expanded, redirected, and even reconceived is at the heart of the May-June 2020 issue of the Hastings Center Report, which is devoted to questions provoked by and lessons emerging during this pandemic.