The ethical permissibility of the “slow code” sparks vigorous debate. However, definitions of the “slow code” that exist in the literature often leave room for interpretation. Thus, those assessing the ethical permissibility of the slow code may not be operating with shared definitions, and definitions may not align with clinicians' understanding and use of the term in clinical practice. To add clarity and nuance to discussions of the “slow code,” this manuscript highlights the salient medical and moral components that distinguish (...) resuscitative practices, resulting in a taxonomy that includes nine distinct entries: the Fake Code, Casual Code, Time‐Limited Code, Family Code, Contained Code, a la Carte Code, Preventive Code, Passive Code, and Accepted Code. We argue that cogent analyses of the ethical implications of the “slow code” must begin with clear, shared understandings of the practices under debate. (shrink)

After briefly reviewing the historical development and ethical regulation of resuscitative technologies, this study probes why clinicians engage in the morally problematic practice of show and slow coding and why hospitals tolerate it? Studies conducted in 1995 and 2020 indicate that conscientious clinicians engage in these practices to protect their patients from abusive or futile resuscitation. And hospitals' clinical cultures tolerate these practices to protect conscientious clinicians from censure, dismissal, delicensing, or legal prosecution for withholding or withdrawing abusive or futile (...) resuscitative technologies without prior patient or surrogate consent. Show and slow coding evolved in American clinical cultures in the second half of the 20th century when closed‐chest cardiac massage, defibrillators, ventilators, and other resuscitative technologies raised seemingly novel ethical questions. To address these questions, bioethics commissions, healthcare societies, lawmakers, and a Roman Catholic Pope developed ethics standards requiring clinicians to obtain patient or surrogate consent before withholding or withdrawing resuscitative technologies. They thus conferred on patients an implicit right of resuscitation even if it was abusive and/or futile. Conscientious clinicians circumvented this implicit right by show and slow coding to protect patients from abusive resuscitation. Recognizing clinicians' benign intent, hospitals' clinical cultures tolerate show and slow coding as acts of conscience, akin to civil disobedience. Thus, rescinding ethics standards and laws requiring prior patient/surrogate consent for non‐resuscitation or for cessation of resuscitative technologies decisions should end show/slow coding. Such a reform should also recognize clinicians' right of conscientious refusal to perform CPR. (shrink)

Slow codes—insincere attempts at resuscitation—are widely regarded in medicine and medical ethics as morally impermissible. My goal here is to enrich this special issue on the slow code with an argument for the permissibility of slow codes that is rooted in moral psychology. Specifically, if we take seriously the results from moral psychology, the slow code is not only permissible, it is often the best option. The context of the decision about whether to perform a slow code is analogous to (...) thoroughly investigated moral dilemmas such as the trolley problem. In particular, when the trolley problem is framed as a trilemma, it becomes clear that the decisional context of the slow code is analogous to the famous moral dilemma. Since in the trolley problem the choice analogous to the slow code is the best choice, the slow code may be the best choice when facing patient or family requests for futile CPR. In establishing this claim, I address a range of objections to the slow code. I conclude with an empirically supported explanation of the conventional wisdom. Resistance to the slow code doesn't sprout from the act's moral properties, but from moral judgments influenced by other factors, such as emotion, physical distance, and personal force. (shrink)

Abstract“Sham codes” or “slow codes”—defined here as resuscitative efforts undertaken only to the extent necessary to convey the impression that “everything was done,” rather than to achieve return of spontaneous circulation (ROSC)—have been almost universally condemned for the past five decades. To facilitate an examination of this practice, we consider how the clinician's obligations and prerogatives differ under four scenarios, all of which involve conflict between the physician who desires to withhold cardiopulmonary resuscitation (CPR) and the family who does not. (...) Under two scenarios, involving quality of life considerations and quantitative futility (“long shots”), we argue that slow codes are ethically impermissible. Under two other scenarios, however, we maintain an agnostic view on the moral permissibility of slow codes. We observe that where the case for impermissibility is predicated on considerations of honesty and professional integrity, commonly practiced and commonly defended alternatives to the slow code, such as non‐initiation of CPR after bedside assessment, limited trials of CPR, and futile CPR, are typically undertaken for beneficent reasons and, like the slow code, entail non‐lying deception. Finally, we offer recommendations for care delivery reform that work “upstream” to prevent the conflicts and crises of trust that give rise to intractable conflicts surrounding CPR. (shrink)

Although cardiopulmonary resuscitation (CPR) was initially used very selectively at the discretion of clinicians, the use of CPR rapidly expanded to the point that it was required to be performed on all patients having in‐hospital cardiac arrests, regardless of the underlying condition. This created problems with CPR being clearly inadvisable for many patients. Do Not Resuscitate (DNR) orders emerged as a means of providing a transparent process for making decisions in advance regarding resuscitation, initially by patients and later also by (...) clinicians. Under hospital policies in many countries, however, CPR remains the default position for all patients having cardiac arrest in the hospital if there is no DNR order in place, regardless of whether CPR is medically indicated or in the patient's best interests. “Slow Codes” are the delayed or token efforts to provide CPR when clinicians feel CPR is futile or inappropriate. After giving a historical overview of the development and the changing use of CPR, we argue that more attention needs to be given to the cause of slow codes, namely, policies requiring CPR to be performed as the default action while simultaneously lacking implementing interventions such as advance care planning as a routine policy. This is ethically and legally inappropriate, and hospital policies should be modified to allow clinicians to consider whether CPR is appropriate at the time of arrest. Such a change requires a stronger emphasis on early recognition of patients for whom CPR is not in their best interests and to improve hospital emergency planning. (shrink)

It is not unusual for patients or families to disagree with healthcare professionals (HCPs) over best treatment options. Conversation typically results and mutually agreeable choices are implemented. Rarely, but increasingly, patients or families will request, even demand, interventions the treating team believes will be ineffective (they will not achieve the intended goal) or inappropriate (the medical or moral harms clearly outweigh any potential benefits). One's duty as an HCP requires one to refuse such interventions, but resulting patient or family conflict (...) makes such refusals challenging, even traumatic, and HCPs often acquiesce. Some states have legal options that protect HCPs and their respective institutions when they make such unilateral choices, but the process is complex, time‐consuming, and emotionally fraught. In this paper, We describe one especially difficult case, using it as a paradigmatic example of when, and why, a slow code is sometimes, if rarely, justified. We also discuss strategies HCPs can use to reduce the need for this, admittedly problematic, solution. (shrink)

As the prevalence of dementia rises, it is increasingly important to determine how to best respect incapable individuals' autonomy during end‐of‐life decisions. Many philosophers advocate for the use of advance directives in these situations to allow capable individuals to outline preferences for their future incapable selves. In this paper, however, I consider whether advance directives lack moral authority in instances of dementia. First, I introduce several scholars who have argued that changes in peoplewith dementia's values throughout disease progression reduce the (...) validity of their advanced wishes. I then outline Karin Jongsma's rejection of this claim, which she calls the “losing and choosing” distinction. Jongsma argues that changes in people with dementia's values should not be respected, because they are unchosen and dictated by the disease. I critique her claim that the process of value change is morally relevant when determining which values we respect. I argue that if individuals with dementia are capable of valuing, their contemporary values should be respected, even when they conflict with past preferences outlined in an advance directive. As such, situations of value change diminish the moral authority of advance directives for individuals with dementia. (shrink)

The term slow code refers to an intentional reduction in the pace or intensity of resuscitative efforts during a medical emergency. This can be understood as an intermediate level between full code (full resuscitation efforts) and no code (no resuscitation efforts) and serves as a symbolic gesture when intervention is considered medically futile. While some previous research acknowledges the slow code as an integral part of clinical practice, many ethicists have condemned the practice as dishonest and causing unnecessary pain for (...) the patient. As the public's views on this issue have been largely absent from the discussion to date, two vignette experiments were performed to investigate their perceptions. The findings indicate that laypersons believe that slow codes are commonplace and often prefer them over a no code. While a full code was perceived as the standard approach and rated most ethical and least punishable, the present results do not support the widespread assumption that laypersons generally oppose slow codes, and this finding should inform ethical discussion and clinical practice. (shrink)

Despite its prevalence today, the practice of purely performative resuscitation (PPR)—paradigmatically, the “slow code”—has attracted more critics in bioethics than defenders. The most common criticism of the slow code is that it's fundamentally deceptive or harmful, while the most common justification offered is that it may benefit the patient's loved ones, by symbolically honoring the patient or the care team's relationship with the family. I argue that critics and defenders of the slow code each have a point. Advocates of the (...) slow code are right that not all PPR is wrongly deceptive or harmful to the patient or his family and that the symbolic aspect of medicine is itself morally significant. But the critics are also correct: slow codes are prima facie wrong. I argue that pursuing a slow code amounts to treating the patient as a tool for others' benefit—hence, treating him as an object—and that this instrumentalizing quality constitutes one core prima facie wrong of the practice. I also build a case for the idea that the slow code may not always be all‐things‐considered wrong, specifying certain limited conditions under which acts of PPR might ultimately be permissible. Thus, the symbolic dimension of medical treatment is indeed morally important, both in morally favorable and in morally problematic respects—namely, in its symbolic denial of the patient's humanity. (shrink)

A popular argument for a right to ectogenic abortions appeals to a right to avoid the obligations associated with parenthood. A common objection to this argument questions whether there are any sufficiently great harms associated with parenthood to ground such a right. I propose a novel formulation of this argument that avoids these objections. I then defend it against important objections.

KEY: Patients or families sometimes demand interventions that are of no benefit or are even harmful. Even in cases where cardiopulmonary resuscitation is futile or medically inappropriate, instituting a do not attempt resuscitation order requires either consent of the patient or family, or working through a cumbersome and conflictual institutional process to change code status over their objection. Sometimes they contest these decisions in court and sometimes they win. Avoiding such conflicts gave rise to the practice of “slow codes,” a (...) situation in which the healthcare team responds to cardiac arrest in a patient in a deliberately slow or perfunctory manner, with the intention of not resuscitating the patient at all. Slow codes have been nearly universally decried as unethical in the literature, at least over the last three decades. After all, a slow code is fundamentally dishonest. But critics tend to avoid the socio‐political and clinical realities that motivate the use of slow codes in the first place. In this article, I argue that in the context of judicial and legislative overreach into medical decision‐making, the slow code serves a distinctly moral purpose beyond promoting the welfare of the patient: It is an act of disobedience against an unethical system. (shrink)

It is often said that it is important for patients to possess hope that their treatment will be successful. We agree, but a widely appealed to type of hope—hope based on conviction (religious or otherwise), renders this assertion problematic. If conviction‐based hope influences patient decisions to undergo medical procedures, then questions are raised about the scope of patient autonomy. Libertarians permit patients to make decisions to undergo medical procedures on the basis of any considerations, including conviction‐based hopes, on grounds of (...) respect for freedom of choice. Rational interventionists want to restrict choices made on the basis of conviction‐based hope on the grounds that choices based on hope incorporate irrationality of a sort incompatible with autonomous decision‐making. In this article, we navigate a middle path between these extremes, arguing that patient decision‐making based on conviction‐based hope ought to be acceptable and permitted in health care when it conforms to norms of practical rationality. These norms allow patients some room to make decisions to consent to undergo medical procedures informed by conviction‐based hope. (shrink)

From an ethical point of view, there is an important distinction between two types of prenatal screening. The first of these targets maternal or foetal conditions (e.g., infectious diseases, blood group sensitization) where early detection allows for interventions that improve the chances of a healthy pregnancy outcome. The second screens for foetal conditions such as Down syndrome, where a timely diagnosis in most cases only allows for a choice between preparation for a child with special needs or termination of the (...) pregnancy. Whereas the former makes an easy fit with the prevention aim of most other population screening programmes, the latter does not. In order to steer clear from a possible eugenic reading of its aim, a wide international consensus has emerged for the view that prenatal screening of this type should have the atypical aim of helping women (couples) to make autonomous reproductive choices, rather than reducing the birth prevalence of the relevant disorders. However, keeping these types of prenatal screening apart may become increasingly difficult given the development of tests, such as the Non‐Invasive Prenatal Test, which cannot only be used for both types of screening but may also lead to interconnected findings on both sides of the divide. This makes it an urgent question: What the aim or aims of this new hybrid screening should be? As neither ‘prevention’ nor ‘autonomy’ will do, we argue for a normative framework that gives both aims their due, while recognizing the tensions between them. (shrink)

A prominent critique of cognitive or athletic enhancement claims that certain performance‐improving drugs or technologies may ‘cheapen’ resulting achievements. Considerably less attention has been paid to the impact of enhancement on the value of moral achievements. Would the use of moral enhancement (bio)technologies, rather than (solely) ‘traditional’ means of moral development like schooling and socialization, cheapen the ‘achievement’ of morally improving oneself? We argue that, to the extent that the ‘cheapened achievement’ objection succeeds in the domains of cognitive or athletic (...) enhancement, it could plausibly also succeed in the domain of moral enhancement—but only regarding certain forms. Specifically, although the value of moral self‐improvement may be diminished by some of the more speculative and impractical forms of moral enhancement proposed in the literature, this worry has less force when applied to more plausibly viable forms of moral enhancement: forms in which drugs or technologies play an adjunctive or facilitative, rather than a determinative, role in moral improvement. We illustrate this idea with three examples from recent literature: the possible use of psychedelic drugs in certain moral‐learning contexts, ‘Socratic Al’ (a proposed Al‐driven moral enhancer) and empathy enhancement through virtual reality (VR). We argue that if one assumes that these technologies work roughly as advertised (which is an open empirical question), the ‘cheapened achievement’ objection loses much of its bite. The takeaway lesson is that moral enhancement in its most promising and practical forms ultimately evades a leading critique of cognitive and athletic enhancement. We end by reflecting on the potential upshot of our analysis for enhancement debates more widely. (shrink)

In the United States, the dominant model of decision‐making capacity (DMC) is the “four abilities model,” which judges DMC according to four criteria: understanding, appreciation, reasoning, and communicating a choice. Some critics argue that this model is “too cognitive” because it ignores the role of emotions and values in decision‐making. But so far there is no consensus about how to incorporate such factors into a model of DMC while still ensuring that patients with unusual or socially disapproved values still have (...) their autonomous decisions respected. In this paper, we aim to give an account of the role of values in decision‐making which can answer some of the lingering questions about capacity. In the current literature, defenders of the inclusion of values in DMC tend to propose solutions which focus on the distorted or incoherent attributes of the values themselves. We argue that shifting the focus onto valuing as an ability is a better solution and that a complete picture of capacity includes understanding, appreciation, reasoning, communicating a choice, and the ability to value. On the basis of a conceptual analysis of the necessary conditions for autonomous decision‐making, we derive a conception of the ability to value. On our account, the ability to value has four components: the possession of values, the ability to access those values, the ability to engage in practical reasoning with one's values, and the ability to act on the result of that reasoning. We describe the positive components of the ability to value, some indicators of impairment, and some implications of our account. (shrink)

The paper offers a critical response to the proposed “dis/analogy” between the restriction of Jehovah's Witness parental right to refuse life‐saving blood transfusions for their minor children and a “general” and “permanent” ban on “unnecessary” pediatric intersex surgery. The main argument of the analogy is “securing the patient's future autonomy.” Feinberg's theory of rights is used to demonstrate that the proposed analogy is untenable. A new category of developmental rights‐in‐trust is introduced to address specific needs of gender development in DSD (...) situations. Both premises are disputed. First, it is shown that the case of overriding Jehovah's Witness parental rights is not based on securing the patient's future autonomy, but a simple dependency right in Feinberg's theory. Second, it is demonstrated that pediatric intersex surgery is not in the same situation in all morally relevant respects as the Jehovah's Witness case because it represents a special type of developmental right‐in‐trust. In conclusion, the arguments based on the proposed analogy do not justify a “general and permanent” on pediatric intersex surgery. (shrink)

The growing demand for uterus transplantation (UTx) invites continued philosophical evaluation of the function of UTx (and what constitutes its ‘success’), as well as the recipient eligibility for UTx. Currently, UTx caters to partnered, cisgender women of childbearing age looking to get pregnant and give birth to a biogenetically related child. The medical justification for this—the treatment of uterine infertility—explains the primacy of this practice. However, this dominant conceptualization of UTx does not necessarily capture the diverse needs for which both (...) cis‐ and transgender women might take interest in UTx that are not strictly procreative, such as bodily integrity and gender identity reasons. In this paper, I argue that non‐procreative motivations for uterus acquisition ought to be taken seriously as a matter of non‐discrimination and consistency. (shrink)

Biobanks are essential biological database resources for the scientific community, enabling research on the molecular, cellular, and genetic basis of human disease. They are crucial for computational, data‐driven biomedical research, which advances precision medicine and the development of targeted therapies. However, biobanks often lack racial and ethnic diversity, with many data sets predominantly comprising individuals of white, primarily northern European, ancestry. Establishing or enhancing biobanks for the inclusion of historically underrepresented populations requires meticulous ethical and social planning beyond logistical, legal, (...) and economic considerations. This guide provides a roadmap for building and sustaining diverse biobanks, emphasizing ethical guidelines and cultural sensitivity. We highlight the importance of obtaining informed consent from donors, respecting their bodily autonomy, and the economic and research benefits of diverse biobanks to enable precision medicine, drug discovery, and industry‐academic partnerships. Prioritizing key ethical and social considerations allows biobanks to advance scientific knowledge while upholding the rights and autonomy of underrepresented populations. Diversity in biobank sample collection enhances research outcomes by ensuring findings are representative and applicable to various human population groups, fostering trust, promoting inclusivity, and addressing health disparities while informing health policy. This is vital to ensuring biobanking efforts contribute meaningfully to the advancement of health equity. (shrink)

Writers have debated whether germline genome‐editing is person‐affecting or identity‐affecting. The difference is thought to be ethically relevant to whether we should choose genome‐editing or choose preimplantation genetic diagnosis and embryo selection, when seeking to prevent or produce bad conditions (e.g., cystic fibrosis, or deafness) in the individuals who will grow from the embryo edited or selected. We consider the very recent views of three prominent bioethicists and philosophers who have grappled with this issue. We claim that both sides are (...) right, but that the sense in which genome‐editing is person‐affecting is less important, morally, when the aim is to have healthy children. Since this is the predominant objective of engaging in embryo selection and genome‐editing, and since there are certain risks, at least for now, with genome‐editing, it remains better, morally, to engage in embryo selection than genome‐editing. (shrink)

The growing demand for uterus transplantation (UTx) invites continued philosophical evaluation of the function of UTx (and what constitutes its ‘success’), as well as the recipient eligibility for UTx. Currently, UTx caters to partnered, cisgender women of childbearing age looking to get pregnant and give birth to a biogenetically related child. The medical justification for this—the treatment of uterine infertility—explains the primacy of this practice. However, this dominant conceptualization of UTx does not necessarily capture the diverse needs for which both (...) cis- and transgender women might take interest in UTx that are not strictly procreative, such as bodily integrity and gender identity reasons. In this paper, I argue that non-procreative motivations for uterus acquisition ought to be taken seriously as a matter of non-discrimination and consistency. (shrink)

Can it be ethical to conduct xenotransplant research on a human brain‐dead decedent (HB‐DD) whose organs could otherwise be given to persons in need? The ethical consensus is that it is better to save existing persons via organ donation than to devote a HB‐DD to research that will not directly benefit anyone. I argue otherwise. Given how rapidly xenotransplant research is progressing, and its clinical promise in the next couple of years or decades, I argue that it can be ethical (...) to conduct xenotransplant research on a HB‐DD whose organs could otherwise be given to individuals in need. (shrink)

Opponents of legalised assisted dying often assert that palliative care is worse in countries where assisted dying has been legalised, and imply that legalised assisted dying makes palliative care worse. This study considers five versions of this claim: that it is difficulty to access expert palliative care in countries where assisted dying has been legalised, that those countries rank low in their quality of end‐of‐life care; that legalising assisted dying doesn't expand patient choice in respect of palliative care; that growth (...) in palliative care services has stalled in countries where assisted dying has been legalised; and that legalised assisted dying impedes the growth of palliative care or causes it to decline. In each case, it concludes that neither argumentation nor evidence supports these claims. (shrink)

Since its launch in November 2022, ChatGPT has become a global phenomenon, sparking widespread public interest in chatbot artificial intelligences (AIs) generally. While not approved for medical use, it is capable of passing all three United States medical licensing exams and offers diagnostic accuracy comparable to a human doctor. It seems inevitable that it, and tools like it, are and will be used by the general public to provide medical diagnostic information or treatment plans. Before we are taken in by (...) the promise of a golden age for chatbot medical AIs, it would be wise to consider the implications of using these tools as either supplements to, or substitutes for, human doctors. With the rise of publicly available chatbot AIs, there has been a keen focus on research into the diagnostic accuracy of these tools. This, however, has left a notable gap in our understanding of the implications for health outcomes of these tools. Diagnosis accuracy is only part of good health care. For example, crucial to positive health outcomes is the doctor–patient relationship. This paper challenges the recent focus on diagnostic accuracy by drawing attention to the causal relationship between doctor–patient relationships and health outcomes arguing that chatbot AIs may even hinder outcomes in numerous ways including subtracting the elements of perception and observation that are crucial to clinical consultations. The paper offers brief suggestions to improve chatbot medical AIs so as to positively impact health outcomes. (shrink)

This study examines the ethical permissibility of biomedical moral enhancement (BME) for psychopaths, considering both coercive and voluntary approaches. To do so, I will first briefly explain what psychopaths are and some normative implications of these facts. I will then ethically examine three scenarios of BME for psychopaths: (1) coercive BME for non‐criminal psychopaths, (2) coercive BME for psychopathic offenders, and (3) voluntary BME for psychopathic offenders. I will argue that coercive BME for non‐criminal psychopaths is ethically problematic due to (...) issues of cost, invasion of privacy, and stigmatic effects of compulsory diagnosis. Similarly, I will argue that coercive BME for criminals is impermissible due to violations of the rights to bodily and mental integrity. However, I will show that voluntary BME for offenders may be ethically permissible under certain conditions, challenging the critique that the consent of vulnerable prisoners cannot be considered fully voluntary. I argue that when an offender is provided with sufficient medical and legal information, incentives such as the possibility of parole review based on BME results do not preclude the voluntariness of consent. Ultimately, I aim to advance the debate on BME for psychopaths by delineating and defending conditions for the ethical permissibility of voluntary BME. (shrink)

Türkiye hosts approximately 3.6 million Syrian refugees, which accounts for roughly 4.5% of Türkiye's population. This places undeniable pressure on public institutions, particularly on healthcare services. The objective of this study is to document the healthcare structure for Syrian refugees and various challenges faced by Syrians when seeking healthcare and to highlight the ethical concerns emerging from those challenges. To achieve this, we conducted a comprehensive review of several qualitative studies and reports conducted by various organizations and institutions, specifically focusing (...) on health or including a dedicated chapter on health issues, published between 2011 and 2023. Following an extensive analysis of the secondary literature, we classified the challenges into three categories: procedural, cultural, and psychosocial. We argue that each of these challenges is linked to overarching medical ethics concerns. Finally, we propose three possible means to mitigate the challenges Syrians experience in accessing and uptake of healthcare services in Türkiye. (shrink)

There is a well‐established asymmetry in our judgments of performance enhancing drugs (PEDs) in sports and in other competitive activities. When an athlete is found using such drugs, it is a scandal that prompts public outrage, fan disappointment, and even loss of title. It seems that we judge enhanced results cannot be genuinely attributed to athletes. There is no similar reaction to use of PEDs in art, science, music, literature, business, and other human endeavors. The question I tackle in this (...) paper is whether this disanalogy is justified: Is there some underlying difference in virtue of which PEDs should be thus stigmatized in sports but not elsewhere? I survey a couple of potential justifications that I find lacking. I then consider the difference in our judgments of the participation of superman‐like characters in sports (which we censure) and in other activities (which we endorse). I argue that the fact that the athlete is human is relevant to the value of sports—and by extension, the status of the effort involved—while this fact plays no significant role with regard to the value of other activities and that this difference in the value of activities ultimately justifies our differing judgments here. I then return to my initial question and examine whether similar appeal to what is human can justify the varying judgments of the use of PEDs. I argue that it can but only under certain assumptions. I conclude by discussing wider implication of my suggestion. (shrink)

This paper discusses children's right to play and its bioethical importance for children affected by war. Against the background of the current military conflicts, it analyses physical, psychological, and institutional factors that limit children's right to play in a situation involving armed conflict. Considering that the lack of institutional support of play for children affected by war constitutes a failure to fulfil our societal and political obligation under Article 31 of the United Nations Convention on the Rights of the Child, (...) this paper analyses the understanding of play adopted in this legal instrument. In line with the distinctions made in the Convention, it discusses the importance of play for children's life and survival, for their health and well‐being, as well as for the recovery of trauma experienced by children affected by armed conflict. It thereby aims to contribute to the recognition and protection of this right on the grounds of bioethics and healthcare. (shrink)

With the continued expansion and commercialisation of fertility treatments, the selection and matching of donors have become more sophisticated and technologised. As part of this landscape, new form of genetic screening: ‘expanded carrier screening’ (ECS) is being offered as a technique to avoid the risk of donors passing on genetic conditions to future offspring. Allowing donors to be tested for hundreds of genetic conditions simultaneously, ECS marks a considerable departure from traditional ‘family history’ models of screening, which rely on an (...) individual's knowledge of family health. There is growing evidence of a drive towards the use of ECS within the fertility sector, and a growing number of clinics are offering it for a fee, as part of an egg or sperm donation cycle or as an add‐on to IVF treatment. In this article, we use methods of critical reflection to synthesise data from two studies to explore how ECS is being used to avoid genetic risk in IVF treatment using donor gametes. We suggest that ECS is a new form of repro‐genetic selection—a selective reproductive technology—with specific and important implications for donors, recipients and clinicians and with the potential to reconfigure the scope and application of gamete donation. We examine these implications and conclude that the existing policy blind spot relating to this development in fertility treatment practice needs to be urgently addressed. (shrink)

This paper explores the notion of loneliness as lack of solidarity in relations to Palestinians living in the Occupied Palestinian Territory, Israel, and the diaspora. Loneliness as lack of solidarity is defined as lacking someone to identify with and/or lacking someone who is willing to assist while carrying a burden. We describe the mechanism of lack of identification using the concept of epistemic injustice. The paper suggests that art may serve as a way to mitigate this kind of loneliness, and (...) focus on the Freedom Theater, which was operating in Jenin Refugee Camp until recently. (shrink)

In this article, we describe in detail the health and general living conditions resulting from the ongoing armed conflict in Yemen, including the historical and geopolitical underpinnings. In addition to mere reporting, we use Yemen as a case study to examine the responsibility of bioethicists in general. We find it unacceptable that bioethics neglects the largest humanitarian crisis taking place in the world at the moment as well as the largest Cholera outbreak in history. We argue that bioethicists should do (...) more to address armed conflicts and their resulting basic human rights violations. We end with a few recommendations to prevent such neglect. (shrink)

The subject of this paper is a critique of the pronatalist metaphysics that underlies bioethics and shapes the thinking and discourse on reproductive rights. The point of reference is the philosophy of antinatalism presented by Marcus T. L. Teo. Seemingly arguing in favor of antinatalism, Teo mixes antinatalist concepts with pronatalist intuitions. The consequence of combining the impossible is the restoration of negative eugenics on the one hand, and a series of contradictions on the other. The article shows that philosophical (...) antinatalism is a universal position that indicates that procreation always, everywhere and for everyone is wrong. The paper simultaneously exposes and criticizes the metaphysics of pronatalism underlying bioethical discourse. Weakening pronatalism in bioethics and turning more attention to antinatalism could bring good results for women, the environment, and bioethics itself in terms of its thematic preferences. (shrink)

This study examines girl child abuse in an internally displaced people's camp in north‐central Nigeria and the response of community health workers. The conflict in Benue State is caused by religious differences between the natives (Tiv people) and the invading Fulani herdsmen. During these conflicts, women and girls were displaced, and they were kept in internally displaced persons (IDPs) located in different parts of the state. Literature has been extensively written on internal displacement in Nigeria, but none has been able (...) to elucidate the health needs of girls and the various abuses girls and women are suffering in IDP camps. In this study, literature was extended (1) to explore the environment of the girl child in IDP camps, (2) to identify reasons for the abuse of the girl child in IDP camps, (3) to investigate the impacts of the abuse on the girl child in IDP camps and (4) to investigate how healthcare workers could be used to alleviate the plight of girl children in IDP camps. This is a qualitative case study, with data obtained from relevant academic literature and personal observation. The data were analysed using content analysis. Findings reveal that the girl child is suffering from psychological, economic and health challenges due to the various forms of abuse they are going through. Following the devastation in Benue State, healthcare workers from the community relocated to neighbouring states. There is a need to recall those healthcare workers and provide them with the necessary materials to assist girls in IDP camps. Recommendations are discussed. (shrink)

Military employees face all sorts of moral dilemmas in their work. The way they resolve these dilemmas—how they decide to act based on their moral deliberations—can have a substantial impact both on society and on their personal lives. Hence, it makes sense to support military employees in dealing with these dilemmas. Military organizations already support their personnel by adopting compliance‐based approaches that focus, for instance, on enforcing moral rules. At the same time, however, they struggle to develop value‐based approaches that (...) could foster moral learning by improving employees' understanding of personal values, others' values, and their responsibility for others. Consequently, military employees are not adequately supported in their ethical decision‐making when confronted with complex situations. To address this issue, drawing on a design research approach, we develop and evaluate the use of a value‐based reflection tool to support military employees with their moral decision‐making. The design and evaluation of the value‐based reflection tool were informed by five semistructured interviews, notes on 45 joint reflection meetings with trainers, and evaluation notes of 755 participants. Our findings suggest the value‐based reflection tool is a promising way to foster actors' moral competence in organizational settings by triggering the social mechanisms of reflection, empathy, and psychological safety. This study is the first to illustrate that value‐based ethics support can complement compliance‐based ethics support in a military organization. Furthermore, it demonstrates design research's potential to develop actionable knowledge for ethics support practices in organizations. (shrink)

This article considers aspects of a development aid that provides medical support to strengthen pediatric orthopedics in Rwanda. We present part of the Afriquia foundation work, a nonprofit foundation from Poland involved in supporting the medical sector in Rwanda as a sign of global solidarity and the human right to health. The main foundation's activity is the treatment of orthopedic problems among Rwandan citizens. We present a case study of two children under the care of the Afiquia foundation. 11‐year‐old Seraphine (...) treated due to the consequences of right tibia osteomyelitis and 11‐year‐old Lavi suffering from osteogenesis imperfecta. Both children were treated surgically in Poland due to Rwanda's lack of treatment possibilities. After the applied treatment, Seraphine walks correctly without crutches and can attend school and thrive among her peers. Lavi has not sustained any fragility fracture since the surgery in Poland. He is healthy and constantly ongoing his rehabilitation including gait training. The described cases initiated development aid in Rwanda, supplying hospitals with orthopedic implants and training medical staff. The growing number of humanitarian crises across the globe and the people affected requires increasing organizations involved in providing relief. The emphasis should be on global education, aiming to make the recipients reflect and prepare them to face humanitarian crises. (shrink)

Proponents of moral enhancement often link certain traits to virtuous behavior but typically focus on average trait scores, neglecting individual behavioral trait variance. Behavioral trait variance refers to the range of behaviors a person exhibits within a trait, which may partly arise from genetic factors independent of mean scores. Using Martha Nussbaum's capabilities approach and virtue ethics, I argue that increasing behavioral trait variance could promote moral flourishing. For example, a consistently disagreeable teacher might excel in specific contexts, like a (...) philosophy seminar. However, such a teacher will struggle to find Aristotle's moral meaning of friendliness, limiting their virtue across diverse contexts. Since social virtues are context‐dependent, reducing behavioral trait variance through personality enhancement could also hinder an individual's ability to achieve virtues or capabilities. This article investigates behavioral trait variance's moral role within virtue ethics and calls for other moral enhancement theories to address the ethical significance of behavioral trait variance and its potential impact on moral flourishing. (shrink)