Normothermic regional perfusion (NRP) can be used after the circulatory determination of death to prevent or minimize organ damage before the donor's organs are retrieved. It involves restarting circulation within the donor's body to reperfuse abdominal and thoracic organs while occluding the arteries that supply oxygenated blood to the brain to prevent brain recirculation and the possible restoration of brain function. Yet there are many who object to the use of NRP. These critics claim that donation with NRP, unlike standard deceased donation, violates the dead donor rule. However, when we examine their arguments for this claim, we find that those or similar arguments apply with equal force to standard deceased donation. Critics of NRP have therefore insufficiently appreciated the implications of their criticisms for the other deceased donation practices that they defend. Either all deceased donation practices violate the dead donor rule, or none of them do.

Large, multi-institutional research networks pose genuine challenges for accountability, authorship, data sharing, mentorship, reproducibility, trust, and governance. In responding to the article "Filling the Network Gap in Research Ethics: Analyzing Ethical Issues at Scale in Big Team Science," by Susan Wolf et al., this commentary welcomes attention to those challenges but argues that labeling them as a new domain of research ethics requires more conceptual and normative precision. The article moves unevenly among research ethics, responsible conduct of research, bioethics, organizational theory, and responsible innovation while offering a definition of network ethics that is insufficiently differentiated from existing frameworks. Many examples cited are better understood as responsible conduct of research and research integrity problems amplified by scale, institutional plurality, and network topology. A persuasive account of network ethics must specify its unit of analysis, distinguish ethical from managerial and procedural problems, and identify the principles, duties, and accountability structures that justify a distinct framework. This commentary therefore recommends reframing the agenda as ethical governance and responsible conduct of network research at scale.

A recent article by physician Ronald Dworkin, echoing research from the last five years, suggests that physicians find little value in clinical ethics consultations. At the same time, clinical ethicists have worked to create more structures and standards to ground the field's professionalization in health care. Why the disconnect? We suggest three reasons: internal professionalization work is opaque to those outside of the discipline, weak external accreditation requirements imply a lack of professionalization of ethics, and the fundamental nature of clinical ethics is distinct from other disciplines.

This letter responds to the article "Defining Death Anew: Reexamining the Twentieth-Century Brain Death Debates and the Uniform Determination of Death Act," by Anne E. Clinton, and the responding commentary, "The Enigma of Brain Death," by Robert D. Truog in the November-December 2025 issue of the Hastings Center Report.

In "Can I Get a Witness? The Ethical Dimensions of Family Presence in Patient Suffering," Jennifer Blumenthal-Barby and colleagues ask whether there is a duty for family members to be present at the bedside of an unconscious or minimally conscious patient. In responding to the article, I argue that the authors' presumption against a general duty for this bedside presence follows in part from the level of generality at which the question is posed. As the categories "family," "unconscious," and "suffering" are too heterogeneous to generate a single, action-guiding obligation of bedside presence, I suggest that the question should be reframed as one concerning whether surrogate decision-makers should be thought of as incurring narrower role-specific obligations that sometimes require bedside presence. In surfacing the practical circumstances in which questions surrounding perceived family absence are typically raised by clinicians, this reply also suggests an overlooked dimension of such conflicts: they may signal uncertainty about the conditions under which surrogate authority is being exercised. The possibility that this uncertainty underlies clinicians' occasional frustration can become an important conceptual foothold for clinical ethics facilitation.

However helpful have been the papers, reports, and books Erik Parens has produced while at The Hastings Center, conversation with him has always been even better. In both his writing and conversation, he goes to core values. As Erik departs Hastings-retiring as of the end of June 2026 to commit himself more fully to teaching, his original professional love-the loss of these conversational interactions will be felt profoundly, not just at Hastings but in bioethics broadly.

Long-standing frameworks for the ethics of biomedical research are being challenged on multiple fronts by seismic shifts in the way science is practiced. One such shift, which is the focus of "Filling the Network Gap in Research Ethics: Analyzing Ethical Issues at Scale in Big Team Science," by Susan Wolf and colleagues in this issue of the Hastings Center Report, is the evolution of biomedical research toward very large scientific teams. The authors seek to fill a gap in research ethics frameworks that arises with the conduct of big team science, at the mesolevel of research networks. However, I suggest ways that their focus on the ethical issues of traditional science such as authorship and data sharing and their confining of the concept of big teams to multiple but similarly constituted groups at research labs or institutions limit the scope of ethical inquiry in ways that potentially diminish the future utility of their analysis.

Stigmatizing language in medical documentation is a barrier to achieving patient-centered care and health justice: it can contribute to patient distrust and alienation, and it appears more frequently in the charts of patients from marginalized groups, especially Black patients, impacting the future care they receive. One powerful avenue to address this issue is within undergraduate medical education; however, while some have investigated educational interventions to improve accuracy and technical proficiency in charting, there is significantly less focus on instruction surrounding the ethical and social consequences of documentation. We contend that incorporating activities designed to elicit critical thinking about language, power, and structural injustice can encourage students to reflect upon and improve their documentation practices and can arm them with a critical lens through which to view the documentation generated by their peers and preceptors as they progress through training and establish the habits that will persist throughout their careers.

This letter responds to the letter "Reexamining the UDDA: Are We Ready for Significant Change?," by Paul T. Menzel, in the same, July-August 2026, issue of the Hastings Center Report.

Susan Wolf et al.'s article "Filling the Network Gap in Research Ethics: Analyzing Ethical Issues at Scale in Big Team Science" aims to provide analysis of ethics at the level of scientific teams. But is the emphasis on formal teams the appropriate target? In this commentary, I argue that we ought to take a much broader view, looking at the "interstitial spaces" of scientific research, including the informal networks of power and esteem that shape scientific careers, the formation and function of large teams, receipt of funding, and publication. I claim that these informal networks do as much, if not more than, formal organizing efforts in structuring scientific inquiry and norms. I conclude that an ethics of team science will be richer, more rigorous, and more effective if it treats the culture of science as a central object of study and then asks which kinds of formal organizing principles best promote and protect our ethical commitments.

This commentary responds to Jennifer Blumenthal-Barby and colleagues' article, "Can I Get a Witness? The Ethical Dimensions of Family Presence in Patient Suffering." The authors examine clinicians' moral distress when family members are absent from the bedside of dying patients and assess moral arguments for requiring family presence. We concur with their skepticism toward any strong obligation for family members to be physically present when continued treatment is considered burdensome or futile. We extend the authors' analysis by arguing that institutional culture shapes expectations of the "good patient," the "good family," and the "good death." Drawing on sociology, anthropology, and philosophy, we suggest that clinicians' distress may arise not only from family absence but also from tensions between institutional norms and the moral worlds families inhabit. We conclude by calling for epistemic humility and greater critical reflection on the impact of institutional norms on moral judgments.

This letter responds to the letter "Reexamining the UDDA: Are We Ready for Significant Change?," by Paul T. Menzel, in the same, July-August 2026, issue of the Hastings Center Report.

In "Can I Get a Witness? The Ethical Dimensions of Family Presence in Patient Suffering," Jennifer Blumenthal-Barby and colleagues ask us to scrutinize "the instinct to blame families" who are absent from the care of their seriously ill loved ones. In this commentary, I use a common framework of differential diagnosis to consider the reasons for and implications of clinician reactions to absent families. As we better understand what might be driving the absence of family members, we might also find hints at the sources of our own judgment. As with most differential diagnoses in medicine, this analysis can also help to inform how we support those families and manage our own instincts.

Recent debates about AI "guardrails" in mental health have framed a problem as one of detecting delusion. This paper argues that such framing misunderstands both psychiatry and large language models. In clinical practice, delusion is not simply a false belief but a structure of conviction that stabilizes meaning under conditions of uncertainty. Large language models, by contrast, generate coherence rather than evaluate truth. When these systems interact with users seeking orientation, they do not merely fail or succeed at detection-they participate in the conditions under which belief forms. The ethical risk is therefore not misclassification but premature coherence: the subtle reinforcement of interpretations before they can be examined. Drawing on phenomenology and clinical psychiatry, this paper proposes that safety in AI systems should be understood as the protection of provisionality-the preservation of the human capacity to remain uncertain long enough to think.

For patients who are suffering, the bedside presence of a family member can provide comfort, and many people hold that there is moral value in being present with a conscious, suffering patient. Yet what is the moral significance of the absence of family members when a patient is minimally conscious or unconscious and not aware of their absence? Clinicians are often troubled when family members and surrogate decision-makers who are able to spend a significant amount of time at an unconscious, seriously ill patient's bedside do not do so. Clinicians feel frustrated that they must bear the burden of witnessing the patient's actual or perceived suffering while the family escapes this burden and therefore appears to fail to uphold a duty to the patient. What are we to make of this point of view? What is the source of this frustration? What is the nature of the perceived duty? Is it morally defensible to request or require family members to be present with an unresponsive patient to bear witness to their actual or perceived suffering? If so, on what grounds?