Social Practices

In one way or another, several pieces in the November-December 2017 of the Hastings Center Report reflect an insistence on turning away from abstractions to learn how a whole community understands a problem at issue-how a community understands what's at stake in individuals' autonomous choices, how a community understands the results of a clinical trial, how a community understands, and generates and adjusts, medical standards. In the lead article, Kayte Spector-Bagdady and colleagues argue that, given extensive research showing that electronic fetal monitoring during childbirth offers very little benefit to the mother and child, a mechanism is needed to ensure that the medical standard of care is based on the right kinds of considerations. The core claim of the second article, by Laura Bothwell and Aaron Kesselheim, is that adaptive-trial designs are premised on the idea that trial designs should be maximally persuasive to the medical community. In the third article, Frederick Zimmerman argues that a richer understanding of autonomy makes it possible to see that public health is more frequently compatible with autonomy than is commonly recognized. A supplement to the issue contains a special report that explores what "just reproduction" means "in the face of multifarious understandings of both justice and autonomy and in light of increasingly complex and costly reproductive technologies."