Year:

  1.  1
    ‘Delusional’ Consent in Somatic Treatment: The Emblematic Case of Electroconvulsive Therapy.Giuseppe Bersani, Francesca Pacitti & Angela Iannitelli - 2020 - Journal of Medical Ethics 46 (6):392-396.
    Even more than for other treatments, great importance must be given to informed consent in the case of electroconvulsive therapy. In a percentage of cases, the symbolic connotation of the treatment, even if mostly and intrinsically negative, may actually be a determining factor in the patient’s motives for giving consent. On an ethical and medicolegal level, the most critical point is that concerning consent to the treatment by a psychotic subject with a severely compromised ability to comprehend the nature and (...)
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  2.  8
    Pandemic Medical Ethics.Jennifer Blumenthal-Barby, Kenneth Boyd, Brian D. Earp, Lucy Frith, Rosalind J. McDougall, John McMillan & Jesse Wall - 2020 - Journal of Medical Ethics 46 (6):353-354.
    The COVID-19 pandemic will generate vexing ethical issues for the foreseeable future and many journals will be open to content that is relevant to our collective effort to meet this challenge. While the pandemic is clearly the critical issue of the moment, it’s important that other issues in medical ethics continue to be addressed as well. As can be seen in this issue, the Journal of Medical Ethics will uphold its commitment to publishing high quality papers on the full array (...)
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  3.  1
    Ethics Briefing.Ruth Campbell, Sophie Brannan, Veronica English, Olivia Lines, Rebecca Mussell & Julian C. Sheather - 2020 - Journal of Medical Ethics 46 (6):397-398.
    Healthcare professionals are currently working under extreme pressure as they respond to the pandemic outbreak of COVID-19. At the time of writing, there is currently no effective vaccine or anti-viral treatment. The pandemic is fast-moving, relatively unpredictable and of uncertain duration. In many countries, it is placing an enormous stress on healthcare resources and providing care to existing standards is proving difficult. Unfortunately, in some countries, health services have been overwhelmed. The impact of the pandemic on resource-poor countries is of (...)
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  4.  1
    Methodological Challenges in Deliberative Empirical Ethics.Stacy M. Carter - 2020 - Journal of Medical Ethics 46 (6):382-383.
    The empirical turn in bioethics and the deliberative turn in democracy theory occurred at around the same time, one at the intersection of bioethics and social science,1 2 the other at the intersection of political philosophy and political science.3–5 Empirical bioethics and deliberative democratic approaches both engage with immediate problems in policy and practice with normative intent, so it was perhaps inevitable that they would eventually find one another,6–8 and that deliberative research would become more common in bioethics.9 This commentary (...)
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  5.  1
    Technological Moral Enhancement or Traditional Moral Progress? Why Not Both?Joao Fabiano - 2020 - Journal of Medical Ethics 46 (6):405-411.
    A new argument has been made against moral enhancement by authors who are otherwise in favour of human enhancement. Additionally, they share the same evolutionary toolkit for analysing human traits as well as the belief that our current morality is unfit to deal with modern problems, such as climate change and nuclear proliferation. The argument is put forward by Buchanan and Powell and states that other paths to moral progress are enough to deal with these problems. Given the likely costs (...)
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  6. Response to Commentaries on ‘Should Free-Text Data in Electronic Medical Records Be Shared for Research? A Citizens’ Jury Study in the UK’.Elizabeth Ford & Malcolm Oswald - 2020 - Journal of Medical Ethics 46 (6):384-385.
    We note a range of interesting and challenging points which take forward the discourse around the ethics of sharing patient data. Of most note are criticisms of our jury recruitment and methods; questioning how we can engender trust and support from the wider, uninformed public when we only have the view of a small informed public; asking what work needs to be done to ethically transfer data from a clinical care setting to that of research; suggesting that dynamic consent with (...)
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  7.  1
    Should Free-Text Data in Electronic Medical Records Be Shared for Research? A Citizens’ Jury Study in the UK.Elizabeth Ford, Malcolm Oswald, Lamiece Hassan, Kyle Bozentko, Goran Nenadic & Jackie Cassell - 2020 - Journal of Medical Ethics 46 (6):367-377.
    BackgroundUse of routinely collected patient data for research and service planning is an explicit policy of the UK National Health Service and UK government. Much clinical information is recorded in free-text letters, reports and notes. These text data are generally lost to research, due to the increased privacy risk compared with structured data. We conducted a citizens’ jury which asked members of the public whether their medical free-text data should be shared for research for public benefit, to inform an ethical (...)
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  8.  1
    Is There a Right Not to Know?John Harris - 2020 - Journal of Medical Ethics 46 (6):414-415.
    In his subtle and well-argued paper,1 Ben Davies argues for a limited but still strong right not to know held by patients against medical professionals. Patients may have such a right against health professionals to be sure, but if and only if, that right has been granted to them by the health professionals in question, their professional body or rules regarding professional conduct. In my judgement, patients do not have a moral RNTK and should have no such legal right neither, (...)
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  9.  3
    The Right to a Self-Determined Death as Expression of the Right to Freedom of Personal Development: The German Constitutional Court Takes a Clear Stand on Assisted Suicide.Ruth Horn - 2020 - Journal of Medical Ethics 46 (6):416-417.
    On 26 February 2020, the German Constitutional Court rejected a law from 2015 that prohibited any form of ‘business-like’ assisted suicide as unconstitutional. The landmark ruling of the highest federal court emphasised the high priority given to the rights of autonomy and free personal development, both of which constitute the principle of human dignity, the first principle of the German constitution. The ruling echoes particularities of post-war Germany’s end-of-life debate focusing on patient self-determination while rejecting any discussion of active assistance (...)
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  10.  6
    Old Consent and New Developments: Health Professionals Should Ask and Not Presume.Rachel Horton, Angela Fenwick & Anneke M. Lucassen - 2020 - Journal of Medical Ethics 46 (6):412-413.
    We thank Lucy Frith for her thought-provoking response1 to our paper, where we argued that it would be ethically acceptable to contact an anonymous egg donor to help facilitate diagnostic genetic testing for a donor-conceived child.2 While we read Frith’s commentary with interest, we still think that the egg donor should be contacted in the case that we describe. Frith raises concerns as to whether contact would constitute ‘ overriding consent ’, thus ’ potentially set a dangerous precedent ’ for (...)
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  11. Remote Monitoring of Medication Adherence and Patient and Industry Responsibilities in a Learning Health System.Junhewk Kim, Austin Connor Kassels, Nathaniel Isaac Costin & Harald Schmidt - 2020 - Journal of Medical Ethics 46 (6):386-391.
    A learning health system seeks to establish a closer connection between clinical care and research and establishes new responsibilities for healthcare providers as well as patients. A new set of technological approaches in medication adherence monitoring can potentially yield valuable data within an LHS, and raises the question of the scope and limitations of patients’ responsibilities to use them. We argue here that, in principle, it is plausible to suggest that patients have a prima facie obligation to use novel adherence (...)
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  12.  4
    From Preferences to Policies? Considerations When Incorporating Empirical Ethics Findings Into Research Policymaking.Emily A. Largent & Stephanie R. Morain - 2020 - Journal of Medical Ethics 46 (6):378-379.
    Interest in the use of medical data for health research is increasing. Yet, as Elizabeth Ford and colleagues rightly note, there are open questions about the suitability of existing ethical and regulatory oversight frameworks for these research approaches. In their feature article, ‘Should free text data in electronic medical records be shared for research? A citizen’s jury study in the United Kingdom’, Ford et al report the results of a deliberative engagement study in which 18 members of the public were (...)
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  13.  24
    Whose Life to Save? Scarce Resources Allocation in the COVID-19 Outbreak.Chiara Mannelli - 2020 - Journal of Medical Ethics 46 (6):364-366.
    After initially emerging in China, the coronavirus outbreak has advanced rapidly. The World Health Organization has recently declared it a pandemic, with Europe becoming its new epicentre. Italy has so far been the most severely hit European country and demand for critical care in the northern region currently exceeds its supply. This raises significant ethical concerns, among which is the allocation of scarce resources. Professionals are considering the prioritisation of patients most likely to survive over those with remote chances, and (...)
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  14.  14
    Balancing the Duty to Treat with the Duty to Family in the Context of the COVID-19 Pandemic.Doug McConnell - 2020 - Journal of Medical Ethics 46 (6):360-363.
    Healthcare systems around the world are struggling to maintain a sufficient workforce to provide adequate care during the COVID-19 pandemic. Staffing problems have been exacerbated by healthcare workers refusing to work out of concern for their families. I sketch a deontological framework for assessing when it is morally permissible for HCWs to abstain from work to protect their families from infection and when it is a dereliction of duty to patients. I argue that it is morally permissible for HCWs to (...)
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  15. Navigating Difficult Decisions in Medical Care and Research.Rosalind J. McDougall - 2020 - Journal of Medical Ethics 46 (6):351-352.
    The articles in this issue explore a number of difficult choices in medical care and research. They investigate ethical complexity in a range of decisions faced by policymakers and clinicians, and offer new evidence or normative approaches for navigating this complexity. In this issue’s feature article, Ford and colleagues engage with an ethical challenge faced by policymakers in relation to health research: should free text data contained in medical records be shared for research purposes?1 While some types of data from (...)
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  16. Research Using Free Text Data in Medical Records Could Benefit From Dynamic Consent and Other Tools for Responsible Governance.Michael Morrison - 2020 - Journal of Medical Ethics 46 (6):380-381.
    As the capacity to generate, store, aggregate and combine ever greater volumes and types of data about individuals, behaviours and interactions continues to expand apace, so too does the challenge of ensuring suitable and appropriate governance of that data. In broad terms, the challenge is simple; how to ensure the benefits of data, such as improvements in service delivery or individual and collective well-being, while avoiding harms such as discrimination, injustice or placing undue burdens on individuals and groups. The difficulty, (...)
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  17.  3
    Considering Medical Assistance in Dying for Minors: The Complexities of Children’s Voices.Harprit Kaur Singh, Mary Ellen Macdonald & Franco A. Carnevale - 2020 - Journal of Medical Ethics 46 (6):399-404.
    Medical assistance in dying legislation in Canada followed much deliberation after the Supreme Court of Canada’s ruling in Carter v. Canada. Included in this deliberation was the Special Joint Committee on Physician Assisted Dying’s recommendation to extend MAID legislation beyond the inclusion of adults to mature minors. Children's agency is a construct advanced within childhood studies literature which entails eliciting children’s voices in order to recognise children as active participants in constructing their own childhoods. Using this framework, we consider the (...)
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  18.  2
    Minority Report: Can Minor Parents Refuse Treatment for Their Child?Helen Lynne Turnham, Ariella Binik & Dominic Wilkinson - 2020 - Journal of Medical Ethics 46 (6):355-359.
    Infants are unable to make their own decisions or express their own wishes about medical procedures and treatments. They rely on surrogates to make decisions for them. Who should be the decision-maker when an infant’s biological parents are also minors? In this paper, we analyse a case in which the biological mother is a child. The central questions raised by the case are whether minor parents should make medical decisions on behalf of an infant, and if so, what are the (...)
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  19.  2
    Some Notes on the Nature and Limits of Posthumous Rights: A Response to Persad.Sean Aas - 2020 - Journal of Medical Ethics 46 (5):345-346.
    A person’s body can, it seems, survive well after losing the capacity to support Lockean personhood. If our rights in our bodies are, basically, rights in our selves or persons, this seems to imply that we do not after all have a right to direct the disposition of our living remains via advance directive. Govind Persad argues that our rights over our bodies persist after the loss of our personhood; we have a right to insist that our bodies die after (...)
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  20.  2
    How Should We Think About Clinical Data Ownership?Angela Ballantyne - 2020 - Journal of Medical Ethics 46 (5):289-294.
    The concept of ‘ownership’ is increasingly central to debates, in the media, health policy and bioethics, about the appropriate management of clinical data. I argue that the language of ownership acts as a metaphor and reflects multiple concerns about current data use and the disenfranchisement of citizens and collectives in the existing data ecosystem. But exactly which core interests and concerns ownership claims allude to remains opaque. Too often, we jump straight from ‘ownership’ to ‘private property’ and conclude ‘the data (...)
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  21. Commentary on ‘The Right Not to Know and the Obligation Not to Know’.Benjamin Berkman - 2020 - Journal of Medical Ethics 46 (5):304-305.
    The idea of a right not to know emerged in the late 20th century, largely in response to the early incorporation of genetic testing into clinical care. While a few commentators took a more absolute view about the strength of the RNTK, most of the scholarship was openly sceptical of the concept, or at least was willing to acknowledge that the RNTK was defeasible.1 After two decades of relative quiet, it was surprising, then, that the RNTK reappeared with a seemingly (...)
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  22.  6
    Ethics in a Time of Coronavirus.Kenneth Boyd - 2020 - Journal of Medical Ethics 46 (5):285-286.
    By the time this issue of the Journal is published, the world will have moved on. More will be known, than at the time of writing this, about how medicine and societies are responding to the ethical challenges presented by the COVID-19 coronavirus pandemic. In his guest editorial,, Dominic Wilkinson writes from the perspective of a UK clinician and ethicist facing the then still impending likelihood that ‘the number of critically ill patients will overwhelm the capacity of intensive care units’ (...)
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  23.  7
    Autonomy, Voluntariness and Assisted Dying.Ben Colburn - 2020 - Journal of Medical Ethics 46 (5):316-319.
    Ethical arguments about assisted dying often focus on whether or not respect for an individual’s autonomy gives a reason to offer them an assisted death if they want it. In this paper, I present an argument for legalising assisted dying which appeals to the autonomy of people who don’t want to die. Adding that option can transform the nature of someone’s choice set, enabling them to pursue other options voluntarily where that would otherwise be harder or impossible. This does not (...)
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  24.  1
    ‘The Right Not to Know and the Obligation to Know’, Response to Commentaries.Ben Davies - 2020 - Journal of Medical Ethics 46 (5):309-310.
    I am grateful for these four incisive commentaries on my paper, ‘The right not to know and the obligation to know’ and regret that I cannot address every point made in these challenging responses to my work. Benjamin Berkman1 worries that I conflate medical information with medical action. I argue that patients sometimes have obligations to receive information, since medical decisions made with incomplete information may generate higher costs. As Berkman notes, though, information is no guarantee of action, and it (...)
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  25.  6
    The Right Not to Know and the Obligation to Know.Ben Davies - 2020 - Journal of Medical Ethics 46 (5):300-303.
    There is significant controversy over whether patients have a ‘right not to know’ information relevant to their health. Some arguments for limiting such a right appeal to potential burdens on others that a patient’s avoidable ignorance might generate. This paper develops this argument by extending it to cases where refusal of relevant information may generate greater demands on a publicly funded healthcare system. In such cases, patients may have an ‘obligation to know’. However, we cannot infer from the fact that (...)
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  26.  1
    Is the Right Not to Know an Instance of ‘Bad Faith’?Aisha Deslandes - 2020 - Journal of Medical Ethics 46 (5):308-308.
    The ‘right not to know’ can be used by patients as a safeguard against the effects that certain medical information can have on their well-being. At first glance, one might reason it suitable for a patient to enact their RNTK. However, although Davies states that RNTK gives people the ability to both protect themselves from self-perceived harm and exercise their autonomy, I will argue that ‘not knowing’ hinders patients’ ability to exercise their existential freedom and represents what Sartre calls an (...)
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  27.  5
    Sexual Rights Puzzle: Re-Solved?Ezio Di Nucci - 2020 - Journal of Medical Ethics 46 (5):337-338.
    My sexual rights puzzle according to which positive sexual rights are not compatible with negative sexual rights has been recently criticised in the Journal of Medical Ethics by Steven J Firth, who has put forward three objections to the puzzle. In this brief response, I analyse and reject each of these three objections.
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  28.  3
    Obligations and Preferences in Knowing and Not Knowing: The Importance of Context.Lisa Dive & Ainsley Janelle Newson - 2020 - Journal of Medical Ethics 46 (5):306-307.
    In healthcare broadly, and especially in genetic medicine, there is an ongoing debate about whether patients have a right not to know information about their own health. The extensive literature on this topic is characterised by a range of different understandings of what it means to have a RNTK,1–9 and how this purported right relates to patient autonomy. Ben Davies considers whether obligations not to place avoidable burdens on a publicly funded healthcare system might form the basis for an obligation (...)
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  29.  9
    Medically Assisted Gender Affirmation: When Children and Parents Disagree.Samuel Dubin, Megan Lane, Shane Morrison, Asa Radix, Uri Belkind, Christian Vercler & David Inwards-Breland - 2020 - Journal of Medical Ethics 46 (5):295-299.
    Institutional guidelines for transgender children and adolescent minors fail to adequately address a critical juncture of care of this population: how to proceed if a minor and their parents have disagreements concerning their gender-affirming medical care. Through arguments based on ethical, paediatric, adolescent and transgender health research, we illustrate ethical dilemmas that may arise in treating transgender and gender diverse youth. We discuss three potential avenues for providing gender-affirming care over parental disagreement: legal carve-outs to parental consent, the mature minor (...)
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  30.  2
    Blame and its Consequences for Healthcare Professionals: Response to Tigard.Elizabeth A. Duthie, Ian C. Fischer & Richard M. Frankel - 2020 - Journal of Medical Ethics 46 (5):339-341.
    Tigard suggests that the medical community would benefit from continuing to promote notions of individual responsibility and blame in healthcare settings. In particular, he contends that blame will promote systematic improvement, both on the individual and institutional levels, by increasing the likelihood that the blameworthy party will ‘own up’ to his or her mistake and apologise. While we agree that communicating regret and offering a genuine apology are critical steps to take when addressing patient harm, the idea that medical professionals (...)
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  31.  1
    Paediatric Xenotransplantation Clinical Trials and the Right to Withdraw.Daniel J. Hurst, Luz A. Padilla, Wendy Walters, James M. Hunter, David K. C. Cooper, Devin M. Eckhoff, David Cleveland & Wayne Paris - 2020 - Journal of Medical Ethics 46 (5):311-315.
    Clinical trials of xenotransplantation may begin early in the next decade, with kidneys from genetically modified pigs transplanted into adult humans. If successful, transplanting pig hearts into children with advanced heart failure may be the next step. Typically, clinical trials have a specified end date, and participants are aware of the amount of time they will be in the study. This is not so with XTx. The current ethical consensus is that XTx recipients must consent to lifelong monitoring. While this (...)
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  32.  13
    Willing Mothers: Ectogenesis and the Role of Gestational Motherhood.Susan Kennedy - 2020 - Journal of Medical Ethics 46 (5):320-327.
    While artificial womb technology is currently being studied for the purpose of improving neonatal care, I contend that this technology ought to be pursued as a means to address the unprecedented rate of unintended pregnancies. But ectogenesis, alongside other emerging reproductive technologies, is problematic insofar as it threatens to disrupt the natural link between procreation and parenthood that is normally thought to generate rights and responsibilities for biological parents. I argue that there remains only one potentially viable account of parenthood: (...)
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  33. Can There Be Wrongful Life at the End of Life? German Courts Revisit an Old Problem in a New Context.Ulrich Pfeifer & Ruth Horn - 2020 - Journal of Medical Ethics 46 (5):348-350.
    This article discusses a recent ruling by the German Federal Court concerning medical professional liability due to potentially unlawful clinically assisted nutrition and hydration at the end of life. This case raises important ethical and legal questions regarding a third person’s right to judge the value of another person’s life and the concept of ‘wrongful life’. In our brief report, we discuss the concepts of the ‘value of life’ and wrongful life, which were evoked by the court, and how these (...)
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  34.  4
    Towards Responsible Ejaculations: The Moral Imperative for Male Contraceptive Responsibility.Arianne Shahvisi - 2020 - Journal of Medical Ethics 46 (5):328-336.
    In this paper, I argue that men should take primary responsibility for protecting against pregnancy. Male long-acting reversible contraceptives are currently in development, and, once approved, should be used as the standard method for avoiding pregnancy. Since women assume the risk of pregnancy when they engage in penis-in-vagina sex, men should do their utmost to ensure that their ejaculations are responsible, otherwise women shoulder a double burden of pregnancy risk plus contraceptive responsibility. Changing the expectations regarding responsibility for contraception would (...)
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  35.  3
    Taking One for the Team: A Reiteration on the Role of Self-Blame After Medical Error.Daniel W. Tigard - 2020 - Journal of Medical Ethics 46 (5):342-344.
    In a critique of my work on ‘taking the blame’ as a response to medical errors, my position on the potential goods of individual responsibility and blame is challenged. It is suggested that medicine is a ‘team sport’ and several rich examples are provided to support the possible harms of practitioner self-blame. Yet, it appears that my critics have misunderstood my demands and to whom they are directed. With this response, I offer several clarifications of my account, as well as (...)
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  36.  6
    ICU Triage in an Impending Crisis: Uncertainty, Pre-Emption and Preparation.Dominic Wilkinson - 2020 - Journal of Medical Ethics 46 (5):287-288.
    The COVID-19 coronavirus pandemic raises a host of challenging ethical questions at every level of society. However, some of the most acute questions relate to decision making in intensive care. The problem is that a small but significant proportion of patients develop severe viral pneumonitis and respiratory failure. It now seems likely that the number of critically ill patients will overwhelm the capacity of intensive care units within many health systems, including the National Health Service in the UK. The experience (...)
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  37.  2
    Implicit Bias, Women Surgeons and Institutional Solutions: Commentary.Samantha Brennan - 2020 - Journal of Medical Ethics 46 (4):246-246.
    This paper argues that a major contribution to women’s under-representation and the gender pay gap in surgery is the interaction and aggregation of many small wrongs, or as they have come to be called in the literature, microinequities. Further, the paper argues that existing strategies do not adequately address the problems faced by women surgeons and cannot do so without an understanding of those wrongs as microinequities. Insights from the literature on ethics and microinequities are thought to be able to (...)
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  38.  1
    Ethics Briefing.Ruth Campbell, Sophie Brannan, Veronica English, Olivia Lines, Rebecca Mussell & Julian C. Sheather - 2020 - Journal of Medical Ethics 46 (4):280-281.
    ### British Medical association survey on physician-assisted dying closes Previous Ethics briefings have highlighted the survey of members on physician-assisted dying being carried out by the British Medical Association.1 This survey closed at midnight on Thursday 27 February. In total, 29 011 members responded – 20.1% of all members who received an invitation to participate – making this one of the largest surveys of medical opinion carried out on this issue, ever. The results of the survey will not make BMA (...)
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  39.  1
    Continuing Conversations About Abortion and Deprivation.Anna Christensen - 2020 - Journal of Medical Ethics 46 (4):275-276.
    In ‘Abortion and deprivation: a reply to Marquis’, I argued that Marquis’ argument about abortion encounters the Epicurean Challenge. In this essay, I continue the conversation begun there. I aim to motivate the Challenge further by examining Marquis’ argument on his own terms and responding to objections about whom death deprives, whether we should focus on the action of killing or the result of death, and how harms suffered before existence compare to harms suffered after death. Finally, I suggest that (...)
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  40.  3
    Have Ignorance and Abuse of Authorship Criteria Decreased Over the Past 15 Years?Evelyne Decullier & Hervé Maisonneuve - 2020 - Journal of Medical Ethics 46 (4):255-258.
    ObjectiveA high prevalence of authorship problems can have a severe impact on the integrity of the research process. We evaluated the authorship practices of clinicians from the same university hospital in 2019 to compare them with our 2003 data and to find out if the practices had changed.MethodsPractitioners were randomly selected from the hospital database. The telephone interviews were conducted by a single researcher using a simplified interview guide compared with the one used in 2003. The doctors were informed that (...)
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  41. Systems Thinking in Gender and Medicine.Brian D. Earp - 2020 - Journal of Medical Ethics 46 (4):225-226.
    If there is a single thread running through this issue of the journal, it may be the complex interplay between the individual and the system of which they are apart, highlighting a need for systems thinking in medical ethics and public health.1 2 Such thinking raises at least three sorts of questions in this context: normative questions about the locus of moral responsibility for change when a system is unjust; practical questions about how to change systems in a way that (...)
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  42. Abortion and the Epicurean Challenge.Karl Ekendahl - 2020 - Journal of Medical Ethics 46 (4):273-274.
    In a recent article in this journal, Anna Christensen raises an ‘Epicurean challenge’ to Don Marquis’ much-discussed argument for the immorality of abortion. According to Marquis’ argument, abortion is pro tanto morally wrong because it deprives the fetus of ‘a future like ours’. Drawing on the Epicurean idea that death cannot harm its victim because there is no subject to be harmed, Christensen argues that neither fetuses nor anyone else can be deprived of a future like ours by dying. Thus, (...)
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  43.  3
    Just Caring: Screening Needs Limits.Leonard Michael Fleck - 2020 - Journal of Medical Ethics 46 (4):253-254.
    This personal narrative tugs at the heart strings. However, personal narratives are not sufficient to justify public funding for any screening policy. We have to take seriously the ‘just caring’ problem. We have only limited resources to meet virtually unlimited health care needs. No doubt, screening tests often save lives. The author wants public funding for prostate-specific antigen screening for prostate cancer. However, why only prostate cancer? Numerous cancers at various stages can be screened for. Are all of them equally (...)
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  44. Prescribing Medical Cannabis: Ethical Considerations for Primary Care Providers.Aaron Glickman & Dominic Sisti - 2020 - Journal of Medical Ethics 46 (4):227-230.
    Medical cannabis is widely available in the USA and legalisation is likely to expand. Despite the increased accessibility and use of medical cannabis, physicians have significant knowledge gaps regarding evidence of clinical benefits and potential harms. We argue that primary care providers have an ethical obligation to develop competency to provide cannabis to appropriate patients. Furthermore, specific ethical considerations should guide the recommendation of medical cannabis. In many cases, these ethical considerations are extensions of well-established principles of beneficence and nonmaleficence, (...)
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  45. Physician, Heal Thyself: A Cross-Sectional Survey of Doctors’ Personal Prescribing Habits.Yvonne Hartnett, Clive Drakeford, Lisa Dunne, Declan M. McLoughlin & Noel Kennedy - 2020 - Journal of Medical Ethics 46 (4):231-235.
    BackgroundSelf-prescribing and prescribing to personal contacts is explicitly discouraged by General Medical Council guidelines.AimsThis study examines how widespread the practice of self-prescribing and prescribing to personal contacts is.MethodsA 16-item questionnaire was distributed via an online forum comprising 4445 young medical doctors, which asked respondents about previous prescribing to themselves, their families, friends and colleagues, including the class of medication prescribed. Demographic details were collected including medical grade and specialty.ResultsA total of 729 responses were obtained, the majority of which were from (...)
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  46.  1
    Four Types of Gender Bias Affecting Women Surgeons and Their Cumulative Impact.Katrina Hutchison - 2020 - Journal of Medical Ethics 46 (4):236-241.
    Women are under-represented in surgery, especially in leadership and academic roles, and face a gender pay gap. There has been little work on the role of implicit biases in women’s under-representation in surgery. Nor has the impact of epistemic injustice, whereby stereotyping influences knowledge or credibility judgements, been explored. This article reports findings of a qualitative in-depth interview study with women surgeons that investigates gender biases in surgery, including subtle types of bias. The study was conducted with 46 women surgeons (...)
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  47.  1
    Wrongdoing and Responsibility in the Context of Cumulative Harms: A Response to Commentators.Katrina Hutchison - 2020 - Journal of Medical Ethics 46 (4):247-248.
    Let me first thank Samantha Brennan, Carolyn McLeod and Brandi Braud Scully for their detailed and constructive commentaries. In this brief response I wish to highlight and engage with three main points they raise. First, I will address McLeod’s argument that female surgeons are not merely harmed, but also wronged by the forms of bias found in the study. Second, I will discuss a concern voiced by both Scully and Brennan that my emphasis on small and implicit biases fails to (...)
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  48.  1
    Decolonising Ideas of Healing in Medical Education.Amali U. Lokugamage, Tharanika Ahillan & S. D. C. Pathberiya - 2020 - Journal of Medical Ethics 46 (4):265-272.
    The legacy of colonial rule has permeated into all aspects of life and contributed to healthcare inequity. In response to the increased interest in social justice, medical educators are thinking of ways to decolonise education and produce doctors who can meet the complex needs of diverse populations. This paper aims to explore decolonising ideas of healing within medical education following recent events including the University College London Medical School’s Decolonising the Medical Curriculum public engagement event, the Wellcome Collection ’s Ayurvedic (...)
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  49.  1
    Design Thinking in Medical Ethics Education.David Marcus, Amanda Simone & Lauren Block - 2020 - Journal of Medical Ethics 46 (4):282-284.
    Background Design thinking is a tool for generating and exploring ideas from multiple stakeholders. We used DT principles to introduce students to the ethical implications of organ transplantation. Students applied DT principles to propose solutions to maximise social justice in liver transplant allocation. Methods A 150 min interactive workshop was integrated into the longitudinal ethics curriculum. Following a group didactic on challenges of organ donation in the USA supplemented by patient stories, teams of students considered alternative solutions to optimise fairness (...)
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  50.  1
    Commentary on ‘Four Types of Gender Bias Affecting Women Surgeons, and Their Cumulative Impact’ by Hutchison.Carolyn McLeod - 2020 - Journal of Medical Ethics 46 (4):242-243.
    The central concerns of Hutchison’s1 paper are the under-representation and unequal pay of women in surgery and the role that subtle gender biases play in explaining these phenomena. My comments will focus on how well executed and important this work is and also why we need more of it to fully understand the gravity of the situation for women in surgery and how it compares with similar situations for women in other fields. Hutchison argues that women in surgery experience many (...)
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  51.  4
    Arrogance of ‘but All You Need is a Good Index Finger’: A Narrative Ethics Exploration of Lack of Universal Funding of PSA Screening in Canada.Jeff Nisker - 2020 - Journal of Medical Ethics 46 (4):249-252.
    This narrative ethics exploration stems from my happy prostate-specific antigen story, though it should not have been, as I annually refuse my family physician’s recommendation to purchase PSA screening. The reason for my refusal is I teach ethics to medical students and of course must walk the talk, and PSA screening is not publicly funded in the province of Ontario, Canada. In addition, I might have taken false comfort in ‘but all you need is a good index finger’ to detect (...)
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  52.  3
    Stop the Bleeding: We Must Combat Explicit as Well as Implicit Biases Affecting Women Surgeons.Brandi Braud Scully - 2020 - Journal of Medical Ethics 46 (4):244-245.
    When I was a 7 months pregnant medical student, an attending surgeon asked me to which specialty I would be applying. When I replied that I was hoping to match in general surgery, he touched my pregnant abdomen and said, “Not with that you’re not.” I am not alone. Gender bias and discrimination have been shown to negatively impact women surgeons throughout their careers and deter women from even applying in surgical fields.1 Bias against female surgical trainees leads to less (...)
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  53.  2
    Understanding Choice, Pressure and Markets in Kidneys.Luke Semrau - 2020 - Journal of Medical Ethics 46 (4):277-278.
    Here, I briefly respond to a recent paper by Julian Koplin, in which he criticises my earlier work in this journal. I show that Koplin has misunderstood the distinction I have made between pressure to vend and pressure with the option to vend. I also show that his pessimism about the market regulations I favour is unwarranted.
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  54. Prioritarian Principles for Digital Health in Low Resource Settings.Niall Winters, Sridhar Venkatapuram, Anne Geniets & Emma Wynne-Bannister - 2020 - Journal of Medical Ethics 46 (4):259-264.
    This theoretical paper argues for prioritarianism as an ethical underpinning for digital health in contexts of extreme disadvantage. In support of this claim, the paper develops three prioritarian principles for making ethical decisions for digital health programme design, grounded in the normative position that the greater the need, the stronger the moral claim. The principles are positioned as an alternative view to the prevailing utilitarian approach to digital health, which the paper argues is not sufficient to address the needs of (...)
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  55.  7
    Should Pregnant Women Be Charged for Non-Invasive Prenatal Screening? Implications for Reproductive Autonomy and Equal Access.Eline M. Bunnik, Adriana Kater-Kuipers, Robert-Jan H. Galjaard & Inez D. de Beaufort - 2020 - Journal of Medical Ethics 46 (3):194-198.
    The introduction of non-invasive prenatal testing in healthcare systems around the world offers an opportunity to reconsider funding policies for prenatal screening. In some countries with universal access healthcare systems, pregnant women and their partners are asked to pay for NIPT. In this paper, we discuss two important rationales for charging women for NIPT: to prevent increased uptake of NIPT and to promote informed choice. First, given the aim of prenatal screening, high or low uptake rates are not intrinsically desirable (...)
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  56.  6
    Understanding People’s ‘Unrealistic Optimism’ About Clinical Research Participation.Hae Lin Cho, David Gibbes Miller & Scott Y. H. Kim - 2020 - Journal of Medical Ethics 46 (3):172-177.
    BackgroundResearchers worry that patients in early-phase research experience unrealistic optimism about benefits and risks of participation. The standard measure of unrealistic optimism is the Comparative Risk/Benefit Assessment questionnaire, which asks people to estimate their chances of an outcome relative to others in similar situations. Such a comparative framework may not be a natural way for research participants to think about their chances.ObjectiveTo examine how people interpret questions measuring unrealistic optimism and how their interpretations are associated with their responses.MethodsUsing an early-phase (...)
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  57.  5
    Ethical Concerns with Online Direct-to-Consumer Pharmaceutical Companies.Henry Curtis & Joseph Milner - 2020 - Journal of Medical Ethics 46 (3):168-171.
    In recent years, online direct-to-consumer pharmaceutical companies have been created as an alternative method for individuals to get prescription medications. While these companies have noble aims to provide easier, more cost-effective access to medication, the fact that these companies both issue prescriptions as well as distribute and ship medications creates multiple ethical concerns. This paper aims to explore two in particular. First, this model creates conflicts of interest for the physicians hired by these companies to write prescriptions. Second, the lack (...)
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  58.  5
    Intergenerational Monitoring in Clinical Trials of Germline Gene Editing.Bryan Cwik - 2020 - Journal of Medical Ethics 46 (3):183-187.
    Design of clinical trials for germline gene editing stretches current accepted standards for human subjects research. Among the challenges involved is a set of issues concerning intergenerational monitoring—long-term follow-up study of subjects and their descendants. Because changes made at the germline would be heritable, germline gene editing could have adverse effects on individuals’ health that can be passed on to future generations. Determining whether germline gene editing is safe and effective for clinical use thus may require intergenerational monitoring. The aim (...)
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  59.  2
    Responding to Simkulet’s Objections to the Two Tragedies Argument.Henrik Friberg-Fernros - 2020 - Journal of Medical Ethics 46 (3):223-224.
    The two tragedies argument has been raised as a response to the argument against abortion from spontaneous abortion. According to this argument against the antiabortion position, miscarriages should be of great concern for proponents of this position since they result in a greater amount of deaths of human beings than induced abortions do. According to critics of AAP, this fact undermines its plausibility, since proponents of the AAP either must try to prevent miscarriages to the same extent as they try (...)
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  60.  2
    Contacting Gamete Donors to Facilitate Diagnostic Genetic Testing for the Donor-Conceived Child: What Are the Rights and Obligations of Gamete Donors in These Cases? A Response to Horton Et Al.Lucy Frith - 2020 - Journal of Medical Ethics 46 (3):220-222.
    In their paper Horton et al argue that it is acceptable to contact an anonymous egg-donor to facilitate diagnostic genetic testing for the donor conceived child, despite the donor, ‘indicating on a historical consent form that she did not wish to take part in future research, and that she did not wish to be informed if she was found to be a carrier of a “harmful inherited condition”’. There are a number of claims embedded in Horton et al’s position that (...)
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  61.  1
    Confused Out of Care: Unanticipated Consequences of a ‘Hostile Environment’.Rose Glennerster & Nathan Hodson - 2020 - Journal of Medical Ethics 46 (3):163-167.
    The UK’s 2014 Immigration Act aimed to create a ‘Hostile Environment’ for migrants to the UK. One aspect of this was the restriction of access to secondary care for overseas visitors to the UK, although it remains the case that everybody living in the UK has the legal right to access primary care. In this paper, we argue that the effects of this policy extend beyond secondary care, including preventing eligible people from registering with a General Practice, although as an (...)
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  62.  19
    On the Ethics of Algorithmic Decision-Making in Healthcare.Thomas Grote & Philipp Berens - 2020 - Journal of Medical Ethics 46 (3):205-211.
    In recent years, a plethora of high-profile scientific publications has been reporting about machine learning algorithms outperforming clinicians in medical diagnosis or treatment recommendations. This has spiked interest in deploying relevant algorithms with the aim of enhancing decision-making in healthcare. In this paper, we argue that instead of straightforwardly enhancing the decision-making capabilities of clinicians and healthcare institutions, deploying machines learning algorithms entails trade-offs at the epistemic and the normative level. Whereas involving machine learning might improve the accuracy of medical (...)
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  63.  10
    The Ethics of Testing and Research of Manufactured Organs on Brain-Dead/Recently Deceased Subjects.Brendan Parent, Bruce Gelb, Stephen Latham, Ariane Lewis, Laura L. Kimberly & Arthur L. Caplan - 2020 - Journal of Medical Ethics 46 (3):199-204.
    Over 115 000 people are waiting for life-saving organ transplants, of whom a small fraction will receive transplants and many others will die while waiting. Existing efforts to expand the number of available organs, including increasing the number of registered donors and procuring organs in uncontrolled environments, are crucial but unlikely to address the shortage in the near future and will not improve donor/recipient compatibility or organ quality. If successful, organ bioengineering can solve the shortage and improve functional outcomes. Studying (...)
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  64. Fetuses, Newborns, and Parental Responsibility.Prabhpal Singh - 2020 - Journal of Medical Ethics 46 (3):188-193.
    I defend a relational account of difference in the moral status between fetuses and newborns. The difference in moral status between a fetus and a newborn is that the newborn baby is the proper object of ‘parental responsibility’ whereas the fetus is not. ‘Parental responsibilities’ are a moral dimension of a ‘parent-child relation’, a relation which newborn babies stand in, but fetuses do not. I defend this relational account by analyzing the concepts of ‘parent’ and ‘child’, and conclude that the (...)
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  65.  3
    Reconceptualising Risk–Benefit Analyses: The Case of HIV Cure Research.Robert Steel - 2020 - Journal of Medical Ethics 46 (3):212-219.
    Modern antiretroviral therapies are capable of suppressing HIV in the bloodstream to undetectable levels. Nonetheless, people living with HIV must maintain lifelong adherence to ART to avoid the re-emergence of the infection. So despite the existence and efficacy of ART, there is still substantial interest in development of a cure. But HIV cure trials can be risky, their success is as of yet unlikely, and the medical gain of being cured is limited against a baseline of ART access. The medical (...)
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  66.  3
    Somewhere Between Dystopia and Utopia.Jesse Wall - 2020 - Journal of Medical Ethics 46 (3):161-162.
    The Journal of Medical Ethics can sometimes read part Men Like Gods and part A Brave New World. At times, we learn how all controversies can resolved with reference to four principles. At other times, we learn how “every discovery in pure science is potentially subversive”.1 This issue is no exception. Here, we can read about the utopia of gene editing, manufactured organs, and machine learnt algorithmic decision-making. We can also read about the dystopia of inherited disorders from edited germlines, (...)
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  67.  9
    First Prosecution of a Dutch Doctor Since the Euthanasia Act of 2002: What Does the Verdict Mean?Eva Constance Alida Asscher & Suzanne van de Vathorst - 2020 - Journal of Medical Ethics 46 (2):71-75.
    On 11 September 2019, the verdict was read in the first prosecution of a doctor for euthanasia since the Termination of Life on Request and Assisted Suicide Act of 2002 was installed in the Netherlands. The case concerned euthanasia on the basis of an advance euthanasia directive for a patient with severe dementia. In this paper we describe the review process for euthanasia cases in the Netherlands. Then we describe the case in detail, the judgement of the Regional Review Committees (...)
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  68.  11
    The End of Religious Exemptions From Immunisation Requirements?Gregory L. Bock - 2020 - Journal of Medical Ethics 46 (2):114-117.
    The purpose of this paper is to propose a middle ground in the debate over religious exemptions from measles vaccination requirements. It attempts to strike a balance between public health concerns on the one hand and religious objections on the other that avoids two equally serious errors: making religious liberty an absolute and disregarding religious beliefs altogether. Some think that the issue is straightforward: science has spoken and the benefits to public health outweigh any other concerns. The safety of the (...)
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  69.  7
    Ethics Briefing.Ruth Campbell, Sophie Brannan, Veronica English, Rebecca Mussell, Julian C. Sheather & Olivia Lines - 2020 - Journal of Medical Ethics 46 (2):159-160.
    In February 2020, the British Medical Association will be surveying members for their views on what the BMA’s position on physician-assisted dying should be. The BMA is currently opposed to physician-assisted dying in all its forms, a position that was agreed in 2006 at the annual representative meeting, the Association’s policy-making conference.1 As previously reported in Ethics briefing,2 the decision to survey members follows a motion passed at last year’s ARM which called on the BMA to “carry out a poll (...)
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  70.  6
    Reproductive Technologies Are Not the Cure for Social Problems.Lisa Campo-Engelstein - 2020 - Journal of Medical Ethics 46 (2):85-86.
    Giulia Cavaliere disagrees with claims that ectogenesis will increase equality and freedom for women, arguing that they often ignore social context and consequently fail to recognise that ectogenesis may not benefit women or it may only benefit a small subset of already privileged women. In this commentary, I will contextualise her argument within the broader cultural milieu to highlight the pattern of reproductive advancements and technologies, such as egg freezing and birth control, being presented as the panacea for women’s inequality. (...)
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  71.  12
    Gestation, Equality and Freedom: Ectogenesis as a Political Perspective.Giulia Cavaliere - 2020 - Journal of Medical Ethics 46 (2):76-82.
    The benefits of full ectogenesis, that is, the gestation of human fetuses outside the maternal womb, for women ground many contemporary authors’ arguments on the ethical desirability of this practice. In this paper, I present and assess two sets of arguments advanced in favour of ectogenesis: arguments stressing ectogenesis’ equality-promoting potential and arguments stressing its freedom-promoting potential. I argue that although successfully grounding a positive case for ectogenesis, these arguments have limitations in terms of their reach and scope. Concerning their (...)
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  72.  8
    ‘Gestation, Equality and Freedom: Ectogenesis as a Political Perspective’ Response to Commentaries.Giulia Cavaliere - 2020 - Journal of Medical Ethics 46 (2):91-92.
    Let me begin by thanking the Journal of Medical Ethics editors and the four commentators for taking time to read, reflect and offer thoughtful comments on my paper. The issues they raise warrant careful attention. Regrettably, I am only able to address some of their key concerns due to space constraints. In my paper, ‘Gestation, Equality and Freedom: Ectogenesis as a Political Perspective’, I outline two sets of critiques of liberal defences of ectogenesis and contend that these defences are limited (...)
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  73.  6
    Commentary on ‘Gestation, Equality and Freedom: Ectogenesis as a Political Perspective’.I. Glenn Cohen - 2020 - Journal of Medical Ethics 46 (2):87-88.
    It is a pleasure to comment on Giulia Cavaliere’s ‘ Gestation, Equality and Freedom: Ectogenesis as a Political Perspective’ in what one might say is ‘enthusiastic disagreement’. The enthusiastic part is because the article is deserving of much praise for adding an important feminist and political theoretical perspective on ectogenesis. The disagreement may come more from disciplinary differences or disposition. As I understand her argument, Cavaliere intends to attack two common arguments in favour of research into ectogenesis—that is, gestation of (...)
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  74.  6
    What Does ‘Quality’ Add? Towards an Ethics of Healthcare Improvement.Alan Cribb, Vikki Entwistle & Polly Mitchell - 2020 - Journal of Medical Ethics 46 (2):118-122.
    In this paper, we argue that there are important ethical questions about healthcare improvement which are underexplored. We start by drawing on two existing literatures: first, the prevailing, primarily governance-oriented, application of ethics to healthcare ‘quality improvement’, and second, the application of QI to healthcare ethics. We show that these are insufficient for ethical analysis of healthcare improvement. In pursuit of a broader agenda for an ethics of healthcare improvement, we note that QI and ethics can, in some respects, be (...)
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  75.  5
    Is the ‘Serious’ Factor in Germline Modification Really Relevant? A Response to Kleiderman, Ravitsky and Knoppers.Iñigo De Miguel Beriain - 2020 - Journal of Medical Ethics 46 (2):151-152.
    Should we use human germline genome modification only when serious diseases are involved? This belief is the underlying factor in the article written by Kleiderman, Ravitsky and Knoppers to which I now respond. In my opinion, the answer to this question should be negative. In this paper, I attempt to show that there are no good reasons to think that this technology should be limited to serious diseases once it is sufficiently proven to be safe and efficient. In fact, opting (...)
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  76.  5
    Betting on CPR: A Modern Version of Pascal’s Wager.David Y. Harari & Robert C. Macauley - 2020 - Journal of Medical Ethics 46 (2):110-113.
    Many patients believe that cardiopulmonary resuscitation is more likely to be successful than it really is in clinical practice. Even when working with accurate information, some nevertheless remain resolute in demanding maximal treatment. They maintain that even if survival after cardiac arrest with CPR is extremely low, the fact remains that it is still greater than the probability of survival after cardiac arrest without CPR. Without realising it, this line of reasoning is strikingly similar to Pascal’s Wager, a Renaissance-era argument (...)
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  77.  3
    Conscientious Objection and Moral Distress: A Relational Ethics Case Study of MAiD in Canada.Mary Kathleen Deutscher Heilman & Tracy J. Trothen - 2020 - Journal of Medical Ethics 46 (2):123-127.
    Conscientious objection has become a divisive topic in recent bioethics publications. Discussion has tended to frame the issue in terms of the rights of the healthcare professional versus the rights of the patient. However, a rights-based approach neglects the relational nature of conscience, and the impact that violating one’s conscience has on the care one provides. Using medical assistance in dying as a case study, we suggest that what has been lacking in the discussion of conscientious objection thus far is (...)
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  78.  3
    Imagine a World… Where Ectogenesis Isn’T Needed to Eliminate Social and Economic Barriers for Women.Claire Horner - 2020 - Journal of Medical Ethics 46 (2):83-84.
    We can imagine a world in which ectogenesis provides a safe gestating space that eliminates maternal morbidity and mortality while maximising healthy outcomes for babies. In this world, women, no longer physically—and visibly—pregnant, are no longer economically, socially or physically disadvantaged due to the potential for pregnancy and birth. Because everyone can access the same technology, women are able to work without fear of pregnancy-related discrimination or restrictions, and health disparities among individuals in gestation and birth based on socioeconomic status (...)
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  79.  3
    ‘Serious’ Science: A Response to Kleiderman, Ravitsky and Knoppers.Satvir Kalsi - 2020 - Journal of Medical Ethics 46 (2):156-157.
    In their paper ‘The “serious” factor in germline modification’, Kleiderman, Ravitsky and Knoppers rightly highlight the ambiguity in the oft-utilised term ‘serious’ in legal discussions of human germline genome modification.1 They suggest interpretation of this term may benefit from a framework based on human rights rather than solely objectivist or constructivist frameworks. In this response, I show the authors provide a narrow and hasty dismissal of objectivist frameworks by defining objectivism broadly as ‘based on biological facts’ early on but later (...)
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  80.  4
    ‘Serious’ Factor—a Relevant Starting Point for Further Debate: A Response.Erika Kleiderman, Vardit Ravitsky & Bartha Maria Knoppers - 2020 - Journal of Medical Ethics 46 (2):153-155.
    In this reply, we wish to defend our original position and address several of the points raised by two excellent responses. The first response questions the relevance of the notion of ‘serious’ within the context of human germline genome modification. We argue that the ‘serious’ factor is relevant and that there is a need for medical and social lenses to delineate the limits of acceptability and initial permissible applications of HGGM. In this way, ‘serious’ acts as a starting point for (...)
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  81.  19
    Education Versus Screening: The Use of Capacity to Consent Tools in Psychiatric Genomics.Camillia Kong, Mehret Efrem & Megan Campbell - 2020 - Journal of Medical Ethics 46 (2):137-143.
    Informed consent procedures for participation in psychiatric genomics research among individuals with mental disorder and intellectual disability can often be unclear, particularly because the underlying ethos guiding consent tools reflects a core ethical tension between safeguarding and inclusion. This tension reflects important debates around the function of consent tools, as well as the contested legitimacy of decision-making capacity thresholds to screen potentially vulnerable participants. Drawing on human rights, person-centred psychiatry and supported decision-making, this paper problematises the use of consent procedures (...)
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  82.  8
    Importance of Systematic Deliberation and Stakeholder Presence: A National Study of Clinical Ethics Committees.Morten Magelssen, Reidar Pedersen, Ingrid Miljeteig, Håvard Ervik & Reidun Førde - 2020 - Journal of Medical Ethics 46 (2):66-70.
    BackgroundCase consultation performed by clinical ethics committees is a complex activity which should be evaluated. Several evaluation studies have reported stakeholder satisfaction in single institutions. The present study was conducted nationwide and compares clinicians’ evaluations on a range of aspects with the CEC’s own evaluation.MethodsProspective questionnaire study involving case consultations at 19 Norwegian CECs for 1 year, where consultations were evaluated by CECs and clinicians who had participated.ResultsEvaluations of 64 case consultations were received. Cases were complex with multiple ethical problems (...)
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  83.  5
    Medical Ethics and Broadening the Context of Debate.John McMillan - 2020 - Journal of Medical Ethics 46 (2):65-65.
    The Journal of Medical Ethics has published a few papers over recent years that explore the ethical implications of ectogenesis.1–4 It is an as yet undeveloped but theoretically possible method by which a fetus can be gestated outside of the womb, and while the prospects of ‘full’ ectogenesis seem some way off, there are techniques that suggest ‘partial’ ectogenesis could be closer. This issue’s Feature Article considers two of the principal arguments that have been developed in favour of ectogenesis being (...)
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  84.  20
    Are the Irreversibly Comatose Still Here? The Destruction of Brains and the Persistence of Persons.Lukas J. Meier - 2020 - Journal of Medical Ethics 46 (2):99-103.
    When an individual is comatose while parts of her brain remain functional, the question arises as to whether any mental characteristics are still associated with this brain, that is, whether the person still exists. Settling this uncertainty requires that one becomes clear about two issues: the type of functional loss that is associated with the respective profile of brain damage and the persistence conditions of persons. Medical case studies can answer the former question, but they are not concerned with the (...)
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  85.  2
    Chromosomal Microarray Analysis in Prenatal Diagnosis: Ethical Considerations of the Belgian Approach.Joke Muys, Bettina Blaumeiser, Katrien Janssens, Patrick Loobuyck & Yves Jacquemyn - 2020 - Journal of Medical Ethics 46 (2):104-109.
    Detection of genetic aberrations in prenatal samples, obtained through amniocentesis or chorion villus biopsy, is increasingly performed using chromosomal microarray, a technique that can uncover both aneuploidies and copy number variants throughout the genome. Despite the obvious benefits of CMA, the decision on implementing the technology is complicated by ethical issues concerning variant interpretation and reporting. In Belgium, uniform guidelines were composed and a shared database for prenatal CMA findings was established. This Belgian approach sparks discussion: it is evidence-based, prevents (...)
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  86.  5
    Will You Give My Kidney Back? Organ Restitution in Living-Related Kidney Transplantation: Ethical Analyses.Eisuke Nakazawa, Keiichiro Yamamoto, Aru Akabayashi, Margie H. Shaw, Richard A. Demme & Akira Akabayashi - 2020 - Journal of Medical Ethics 46 (2):144-150.
    In this article, we perform a thought experiment about living donor kidney transplantation. If a living kidney donor becomes in need of renal replacement treatment due to dysfunction of the remaining kidney after donation, can the donor ask the recipient to give back the kidney that had been donated? We call this problem organ restitution and discussed it from the ethical viewpoint. Living organ transplantation is a kind of ‘designated donation’ and subsequently has a contract-like character. First, assuming a case (...)
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  87.  1
    Partial Ectogenesis: Freedom, Equality and Political Perspective.Elizabeth Chloe Romanis - 2020 - Journal of Medical Ethics 46 (2):89-90.
    In this commentary, I consider how Giulia Cavaliere’s arguments about the limited reach of the current justifications offered for full ectogenesis in the bioethical literature apply in the context of partial ectogenesis. I suggest that considering the extent to which partial ectogenesis is freedom or equality promoting is more urgent because of the more realistic prospect of artificial womb technology being utilised to facilitate partial gestation extra uterum as opposed to facilitating complete gestation from conception to term. I highlight concerns (...)
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  88.  9
    Abortion and Ectogenesis: Moral Compromise.William Simkulet - 2020 - Journal of Medical Ethics 46 (2):93-98.
    The contemporary philosophical literature on abortion primarily revolves around three seemingly intractable debates, concerning the moral status of the fetus, scope of women’s rights and moral relevance of the killing/letting die distinction. The possibility of ectogenesis—technology that would allow a fetus to develop outside of a gestational mother’s womb—presents a unique opportunity for moral compromise. Here, I argue those opposed to abortion have a prima facie moral obligation to pursue ectogenesis technology and provide ectogenesis for disconnected fetuses as part of (...)
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  89. Ethics of Socially Assistive Robots in Aged-Care Settings: A Socio-Historical Contextualisation.Tijs Vandemeulebroucke, Bernadette Dierckx de Casterlé & Chris Gastmans - 2020 - Journal of Medical Ethics 46 (2):128-136.
    Different embodiments of technology permeate all layers of public and private domains in society. In the public domain of aged care, attention is increasingly focused on the use of socially assistive robots supporting caregivers and older adults to guarantee that older adults receive care. The introduction of SARs in aged-care contexts is joint by intensive empirical and philosophical research. Although these efforts merit praise, current empirical and philosophical research are still too far separated. Strengthening the connection between these two fields (...)
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  90.  6
    Worth Living or Worth Dying? The Views of the General Public About Allowing Disabled Children to Die.Claudia Brick, Guy Kahane, Dominic Wilkinson, Lucius Caviola & Julian Savulescu - 2020 - Journal of Medical Ethics 46 (1):7-15.
    BackgroundDecisions about withdrawal of life support for infants have given rise to legal battles between physicians and parents creating intense media attention. It is unclear how we should evaluate when life is no longer worth living for an infant. Public attitudes towards treatment withdrawal and the role of parents in situations of disagreement have not previously been assessed.MethodsAn online survey was conducted with a sample of the UK public to assess public views about the benefit of life in hypothetical cases (...)
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  91.  9
    Frequently Overlooked Realistic Moral Bioenhancement Interventions.Gregory Mark Conan - 2020 - Journal of Medical Ethics 46 (1):43-47.
    Many supporters of ‘moral bioenhancement’, the use of biomedical interventions for moral improvement, have been criticised for having unrealistic proposals. The interventions they suggest have often been called infeasible and their implementation plans vague or unethical. I dispute these criticisms by showing that various interventions to implement MBE are practically and ethically feasible enough to warrant serious consideration. Such interventions include transcranial direct current stimulation over the medial and dorsolateral prefrontal cortex, as well as supplementation with lithium and omega-3. Considering (...)
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  92.  14
    Continuing the Conversation About Medical Assistance in Dying.Carey DeMichelis, Randi Zlotnik Shaul & Adam Rapoport - 2020 - Journal of Medical Ethics 46 (1):53-54.
    In their summary and critique, Gamble, Gamble, and Pruski mischaracterise both the central arguments and the primary objectives of our original paper. Our paper does not provide an ethical justification for paediatric Medical Assistance in Dying by comparing it with other end of life care options. In fact, it does not offer arguments about the permissibility of MAID for capable young people at all. Instead, our paper focuses on the ethical questions that emerged as we worked to develop a policy (...)
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  93.  4
    The Concise Argument.Lucy Frith - 2020 - Journal of Medical Ethics 46 (1):1-2.
    This post-holiday edition of the JME brings together a number of papers, covering a range of methodologies, surveys on public opinion, the application of developmental neuroscience, comparative risk/benefit questionnaires, scoping reviews and analysis of guidance and health policy, alongside what might be seen as more traditional medical ethics, analysing concepts and advancing arguments. This range of methodologies is suggestive of the kind of discipline that bioethics has become, and how a wealth of disciplinary and methodological perspectives is needed to address (...)
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  94.  8
    Ethical End-of-Life Palliative Care: Response to Riisfeldt.Heidi Giebel - 2020 - Journal of Medical Ethics 46 (1):51-52.
    In a recent article, 1 Riisfeldt attempts to show that the principle of double effect is unsound as an ethical principle and problematic in its application to palliative opioid and sedative use in end-of-life care. Specifically, he claims that routine, non-lethal opioid and sedative administration may be “intrinsically bad” by PDE’s standards, continuous deep palliative sedation should be treated as a bad effect akin to death for purposes of PDE, PDE cannot coherently be applied in cases where death “indirectly” furthers (...)
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  95.  8
    Deciding When a Life is Not Worth Living: An Imperative to Measure What Matters.Monica E. Lemmon - 2020 - Journal of Medical Ethics 46 (1):18-19.
    As a neonatal neurologist, I serve families facing tragic decisions in which they must balance trade-offs between death and life with profound disability. I often find myself in complex discussions about future outcome, in which families sort through in real-time what information they value most in making such a choice. Will he laugh? Will he be in pain? Will he know how much he’s loved? In this month’s feature article, Brick et al share the results of an online survey aimed (...)
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  96.  6
    Distinction Between Euthanasia and Palliative Sedation is Clear-Cut.Lars Johan Materstvedt - 2020 - Journal of Medical Ethics 46 (1):55-56.
    This article is a response to Thomas David Riisfeldt’s paper entitled ‘Weakening the ethical distinction between euthanasia, palliative opioid use and palliative sedation’. It is shown that as far as euthanasia and palliative sedation are concerned, Riisfeldt has not established that a common ground, or a similarity, between the two is the relief of suffering. Quite the contrary, this is not characteristic of euthanasia, neither by definition nor from a clinical point of view. Hence, the argument hinges on a conceptually (...)
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  97.  5
    Public Views About Quality of Life and Treatment Withdrawal in Infants: Limitations and Directions for Future Research.Ryan H. Nelson - 2020 - Journal of Medical Ethics 46 (1):20-21.
    Work done within the realm of what is sometimes called ‘descriptive ethics’ brings two questions readily to mind: How can empirical findings, in general, inform normative debates? and How can these empirical findings, in particular, inform the normative debate at hand? Brick et al 1 confront these questions in their novel investigation of public views about lives worth living and the permissibility of withdrawing life-sustaining treatment from critically ill infants. Mindful of the is-ought gap, the authors suggest modestly that their (...)
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  98.  6
    Training Clinical Ethics Committee Members Between 1992 and 2017: Systematic Scoping Review.Yun Ting Ong, Nicholas Yue Shuen Yoon, Hong Wei Yap, Elijah Gin Lim, Kuang Teck Tay, Ying Pin Toh, Annelissa Chin & Lalit Kumar Radha Krishna - 2020 - Journal of Medical Ethics 46 (1):36-42.
    IntroductionClinical ethics committees support and enhance communication and complex decision making, educate healthcare professionals and the public on ethical matters and maintain standards of care. However, a consistent approach to training members of CECs is lacking. A systematic scoping review was conducted to evaluate prevailing CEC training curricula to guide the design of an evidence-based approach.MethodsArksey and O’Malley’s methodological framework for conducting scoping reviews was used to evaluate prevailing accounts of CEC training published in six databases. Braun and Clarke’s thematic (...)
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  99.  8
    A Response to Critics: Weakening the Ethical Distinction Between Euthanasia, Palliative Opioid Use and Palliative Sedation.Thomas D. Riisfeldt - 2020 - Journal of Medical Ethics 46 (1):59-62.
    My essay ‘Weakening the ethical distinction between euthanasia, palliative opioid use and palliative sedation’ has recently generated some critique which I will attempt to address in this response. Regarding the empirical question of whether palliative opioid and sedative use shorten survival time, Schofield et al raise the three concerns that my literature review contains a cherry-picking bias through focusing solely on the palliative care population, that continuous deep palliative sedation falls beyond the scope of routine palliative care, and that my (...)
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  100.  24
    Palliative Opioid Use, Palliative Sedation and Euthanasia: Reaffirming the Distinction.Guy Schofield, Idris Baker, Rachel Bullock, Hannah Clare, Paul Clark, Derek Willis, Craig Gannon & Rob George - 2020 - Journal of Medical Ethics 46 (1):48-50.
    We read with interest the extended essay published from Riisfeldt and are encouraged by an empirical ethics article which attempts to ground theory and its claims in the real world. However, such attempts also have real-world consequences. We are concerned to read the paper’s conclusion that clinical evidence weakens the distinction between euthanasia and normal palliative care prescribing. This is important. Globally, the most significant barrier to adequate symptom control in people with life-limiting illness is poor access to opioid analgesia. (...)
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  101.  8
    Strengthening the Ethical Distinction Between Euthanasia, Palliative Opioid Use and Palliative Sedation.Xavier Symons - 2020 - Journal of Medical Ethics 46 (1):57-58.
    Thomas Riisfeldt’s essay1 is a valuable contribution to the literature on palliative sedation, appropriately titrated administration of opioids and euthanasia. In this response, I will not deal with the author’s empirical claim about the relationship between opioid use, palliative sedation and survival time. Rather, I will briefly critique the author’s discussion of doctrine of double effect and its application to palliative sedation and opioid use at the end of life. That is, I will focus on the ethical claims made by (...)
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  102.  5
    Is ‘Best Interests’ the Right Standard in Cases Like That of Charlie Gard?Robert D. Truog - 2020 - Journal of Medical Ethics 46 (1):16-17.
    Savulescu and colleagues have provided interesting insights into how the UK public view the ‘best interests’ of children like Charlie Gard. But is best interests the right standard for evaluating these types of cases? In the USA, both clinical decisions and legal judgments tend to follow the ‘harm principle’, which holds that parental choices for their children should prevail unless their decisions subject the child to avoidable harm. The case of Charlie Gard, and others like it, show how the USA (...)
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  103.  11
    In Response to an Argument Against Penile Transplantation.André Van der Merwe - 2020 - Journal of Medical Ethics 46 (1):63-64.
    Moodley and Rennie’s paper arguing against penile transplantation stated out of context arguments and wrongly quoted statements. The cost of penile transplantation is much less than portrayed. The burden of cases is much less than is communicated. The men on our penis transplantation programme represent the poorest of the poor and are one of the most discriminated against groups of humans on earth. The false hope said to be created by Moodley is indeed not false hope at all as there (...)
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  104. Randomised Evaluation of Government Health Programmes Does Present a Challenge to Standard Research Ethics Frameworks.Samuel I. Watson, Mary Dixon-Woods & Richard J. Lilford - 2020 - Journal of Medical Ethics 46 (1):34-35.
    In a recent issue of Journal of Medical Ethics, we discussed the ethical review of evaluations of interventions that would occur whether or not the evaluation was taking place. We concluded that standard research ethics frameworks including the Ottawa Statement, which requires justification for all aspects of an intervention and its roll-out, were a poor guide in this area. We proposed that a consideration of researcher responsibility, based on the consequences of the research taking place, would be a more appropriate (...)
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  105.  1
    Revising Ethical Guidance for the Evaluation of Programmes and Interventions Not Initiated by Researchers.Samuel I. Watson, Mary Dixon-Woods, Celia A. Taylor, Emily B. Wroe, Elizabeth L. Dunbar, Peter J. Chilton & Richard J. Lilford - 2020 - Journal of Medical Ethics 46 (1):26-30.
    Public health and service delivery programmes, interventions and policies are typically developed and implemented for the primary purpose of effecting change rather than generating knowledge. Nonetheless, evaluations of these programmes may produce valuable learning that helps determine effectiveness and costs as well as informing design and implementation of future programmes. Such studies might be termed ‘opportunistic evaluations’, since they are responsive to emergent opportunities rather than being studies of interventions that are initiated or designed by researchers. However, current ethical guidance (...)
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  106.  1
    Ottawa Statement Does Not Impede Randomised Evaluation of Government Health Programmes.Charles Weijer & Monica Taljaard - 2020 - Journal of Medical Ethics 46 (1):31-33.
    In this issue of JME, Watson et al call for research evaluation of government health programmes and identify ethical guidance, including the Ottawa Statement on the ethical design and conduct of cluster randomised trials, as a hindrance. While cluster randomised trials of health programmes as a whole should be evaluated by research ethics committees, Watson et al argue that the health programme per se is not within the researcher’s control or responsibility and, thus, is out of scope for ethics review. (...)
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  107.  4
    Relationships Help Make Life Worth Living.Aaron Wightman, Benjamin S. Wilfond, Douglas Diekema, Erin Paquette & Seema Shah - 2020 - Journal of Medical Ethics 46 (1):22-23.
    Decisions regarding life-sustaining medical treatments for young children with profound disabilities can be extremely challenging for families and clinicians. In this study, Brick and colleagues1 surveyed adult residents of the UK about their attitudes regarding withdrawal of treatment using a series of vignettes of infants with varying levels of intellectual and physical disability, based on real and hypothetical cases.1 This is an interesting study on an important topic. We first highlight the limitations of using these survey data to inform public (...)
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  108.  14
    The Relational Threshold: A Life That is Valued, or a Life of Value?Dominic Wilkinson, Claudia Brick, Guy Kahane & Julian Savulescu - 2020 - Journal of Medical Ethics 46 (1):24-25.
    The four thoughtful commentaries on our feature article draw out interesting empirical and normative questions. The aim of our study was to examine the views of a sample of the general public about a set of cases of disputed treatment for severely impaired infants.1 We compared those views with legal determinations that treatment was or was not in the infants’ best interests, and with some published ethical frameworks for decisions. We deliberately did not draw explicit ethical conclusions from our survey (...)
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  109. Unethical Informed Consent Caused by Overlooking Poorly Measured Nocebo Effects.Jeremy Howick - 2020 - Journal of Medical Ethics 16:00-03.
    Unlike its friendly cousin the placebo effect, the nocebo effect (the effect of expecting a negative outcome) has been almost ignored. Epistemic and ethical confusions related to its existence have gone all but unnoticed. Contrary to what is often asserted, adverse events following from taking placebo interventions are not necessarily nocebo effects; they could have arisen due to natural history. Meanwhile, ethical informed consent (in clinical trials and clinical practice) has centred almost exclusively on the need to inform patients about (...)
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  110. Questionable Benefits and Unavoidable Personal Beliefs: Defending Conscientious Objection for Abortion.Bruce Philip Blackshaw & Daniel Rodger - 2020 - Journal of Medical Ethics 3 (46):178-182.
    Conscientious objection in healthcare has come under heavy criticism on two grounds recently, particularly regarding abortion provision. First, critics claim conscientious objection involves a refusal to provide a legal and beneficial procedure requested by a patient, denying them access to healthcare. Second, they argue the exercise of conscientious objection is based on unverifiable personal beliefs. These characteristics, it is claimed, disqualify conscientious objection in healthcare. Here, we defend conscientious objection in the context of abortion provision. We show that abortion has (...)
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  111.  24
    Parental Responsibilities and Moral Status.Bruce P. Blackshaw & Daniel Rodger - 2020 - Journal of Medical Ethics 1:1-2.
    Prabhpal Singh has recently defended a relational account of the difference in moral status between fetuses and newborns as a way of explaining why abortion is permissible and infanticide is not. He claims that only a newborn can stand in a parent–child relation, not a fetus, and this relation has a moral dimension that bestows moral value. We challenge Singh’s reasoning, arguing that the case he presents is unconvincing. We suggest that the parent–child relation is better understood as an extension (...)
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  112.  2
    Technological Moral Enhancement or Traditional Moral Progress? Why Not Both?Joao Fabiano - 2020 - Journal of Medical Ethics 1:medethics-2019-105915.
    A new argument has been made against moral enhancement by authors who are otherwise in favour of human enhancement. Additionally, they share the same evolutionary toolkit for analysing human traits as well as the belief that our current morality is unfit to deal with modern problems, such as climate change and nuclear proliferation. The argument is put forward by Buchanan and Powell and states that other paths to moral progress are enough to deal with these problems. Given the likely costs (...)
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  113.  38
    Defending the Distinction Between Pregnancy and Parenthood.Prabhpal Singh - 2020 - Journal of Medical Ethics 1:1-3.
    In this paper, I respond to criticisms toward my account of the difference in moral status between fetuses and newborns. I show my critics have not adequately argued for their view that pregnant women participate in a parent-child relationship. While an important counterexample is raised against my account, this counterexample had already been dealt with in my original paper. Because the criticisms against my account lack argumentative support, they do not pose a problem for my account. I conclude the raised (...)
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