Journal of Medical Ethics

ISSN: 0306-6800

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  1.  6
    Revisiting the comparison between healthcare strikes and just war.Luke Brunning - 2023 - Journal of Medical Ethics 49 (12):799-802.
    In the UK, healthcare workers are again considering whether to strike, and the moral status of strike action is being publicly debated. Mpho Selemogo argued that we can think productively about the ethical status of healthcare strikes by using the ethical framework often applied to armed conflict (2014). On this view, strikes need to be just, proportionate, likely to succeed, a last resort, pursued by a legitimate organisation and publicly communicated. In this article, I argue for a different approach to (...)
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  2.  4
    Primary duty is to communicate moment-in-time nature of genetic variant interpretation.Carolyn Riley Chapman - 2023 - Journal of Medical Ethics 49 (12):817-818.
    In late 2021, tennis star Chris Evert learned new genetic information about her sister, who died from ovarian cancer in January 2020. As Evert has explained in posts published by ESPN, her sister had a variant in the BRCA1 gene that was reclassified—upgraded—from a variant of uncertain significance (VUS) to pathogenic. Hearing about the variant’s reclassification likely saved Evert’s life. After getting genetic testing that showed she also carried the variant, Evert underwent prophylactic surgery. Clinical testing associated with the procedure (...)
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  3.  4
    Mapping out the arguments for and against patient non-attendance fees in healthcare: an analysis of public consultation documents.Joar Røkke Fystro & Eli Feiring - 2023 - Journal of Medical Ethics 49 (12):844-849.
    BackgroundPatients not attending their appointments without giving notice burden healthcare services. To reduce non-attendance rates, patient non-attendance fees have been introduced in various settings. Although some argue in narrow economic terms that behavioural change as a result of financial incentives is a voluntary transaction, charging patients for non-attendance remains controversial. This paper aims to investigate the controversies of implementing patient non-attendance fees.ObjectiveThe aim was to map out the arguments in the Norwegian public debate concerning the introduction and use of patient (...)
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  4.  3
    Whose models? Which representations? A response to Wagner.Doug Hardman & Phil Hutchinson - 2023 - Journal of Medical Ethics 49 (12):850-851.
    InWhere the Ethical Action Is,we argued that medical and ethical modes of thought are not different in kind but different aspects of a situation. One of the consequences of this argument is that the requirement for or benefits of normative moral theorising in bioethics is undercut. In response, Wagner has argued that normative moral theories should be reconceived as models. Wagner’s argument seems to be that once reconceived as models, the rationale for moral theorising, undercut by our arguments inWhere the (...)
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  5.  1
    Harnessing legal structures of virtue for planetary health.Eric C. Ip - 2023 - Journal of Medical Ethics 49 (12):833-837.
    Humans and other species depend on the planet’s well-being to survive and flourish. The health of the planet and its ecosystems is under threat from anthropogenic climate change, pollution and biodiversity loss. The promotion of planetary health against entrenched degradation of nature urgently requires ethical guidance. Using an ecocentric virtue jurisprudence approach, this article argues that the highest end of safeguarding planetary health is to secure the flourishing of the Earth community, of which the flourishing of humanity is but one (...)
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  6.  5
    Machine learning models, trusted research environments and UK health data: ensuring a safe and beneficial future for AI development in healthcare.Charalampia Kerasidou, Maeve Malone, Angela Daly & Francesco Tava - 2023 - Journal of Medical Ethics 49 (12):838-843.
    Digitalisation of health and the use of health data in artificial intelligence, and machine learning (ML), including for applications that will then in turn be used in healthcare are major themes permeating current UK and other countries’ healthcare systems and policies. Obtaining rich and representative data is key for robust ML development, and UK health data sets are particularly attractive sources for this. However, ensuring that such research and development is in the public interest, produces public benefit and preserves privacy (...)
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  7.  1
    Professionalism or prejudice? Modelling roles, risking microaggressions.Emily Miller, Sonya Tang Girdwood, Anita Shah, Chidiogo Anyigbo & Elizabeth Lanphier - 2023 - Journal of Medical Ethics 49 (12):822-823.
    We agree with McCullough, Coverdale and Chervenak1 that ‘medical educators and academic leaders are in a pivotal and powerful position to role model’ to counter ‘incivility’ in medicine, which can include ‘dismissing’ or ‘demeaning others’. They note that ‘women may be at greater risk for experiencing incivility compared with men’, as may other individuals who experience ‘patterns of disrespect based on minority status’. The authors promote ‘professionalism’ and ‘etiquette’ to foster civility within medicine. Yet theory and experience suggest that medical (...)
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  8.  2
    Ethics briefings.Rebecca Mussell & Danielle Hamm - 2023 - Journal of Medical Ethics 49 (12):861-862.
    Health will feature more prominently at this year’s United Nations Conference of the Parties (COP) to the Framework Convention on Climate Change. COP281 will include a ‘Health/Relief/Recovery and Peace’ day on the 3 December. The health day inevitably engages issues of equity and justice. It includes perspectives on identifying and scaling up adaption measures to address health impacts of climate change, acknowledging ‘findings that climate-sensitive health risks are disproportionately felt by the most vulnerable and disadvantaged, including women, children, ethnic minorities, (...)
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  9.  3
    Downgrades: a potential source of moral tension.Anke J. M. Oerlemans, Ilse Feenstra, Helger G. Yntema & Marianne Boenink - 2023 - Journal of Medical Ethics 49 (12):815-816.
    While Gabriel Watts and Ainsley Newson argue that diagnostic laboratories do not have a general duty to routinely reinterpret genomic variant classifications, they do formulate several restricted duties to actively reinterpret specific types of classifications.1 They place these duties with laboratories, acknowledging that they are setting aside any responsibilities that might arise for clinicians. Here, we will discuss the implications of this obligation for clinicians and the moral tension it may confront them with. We focus in particular on the consequences (...)
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  10.  19
    Opt-out paradigms for deceased organ donation are ethically incoherent.G. M. Qurashi - 2023 - Journal of Medical Ethics 49 (12):854-859.
    The Organ Donation Act 2019 has introduced an opt-out organ donor register in England, meaning that consent to the donation of organs upon death is presumed unless an objection during life was actively expressed. By assessing the rights of the dead over their organs, the sick to those same organs, and the role of consent in their requisition, this paper interrogates whether such paradigms for deceased organ donation are ethically justifiable. Where legal considerations are applicable, I focus on the recent (...)
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  11.  2
    Promoting diagnostic equity: specifying genetic similarity rather than race or ethnicity.Katherine Witte Saylor & Daphne Oluwaseun Martschenko - 2023 - Journal of Medical Ethics 49 (12):820-821.
    In their article on the limited duty to reinterpret genetic variants, Watts and Newson argue that clinical labs are not morally obligated to conduct routine reinterpretation despite its potential clinical and personal value.1 We endorse the authors’ argument for a circumscribed duty to reclassify genomic variants in certain cases, including to promote diagnostic equity for racial and ethnic minority populations that have been historically excluded from and exploited by genomic research and medicine. However, given the history and resilience of scientific (...)
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  12. Equity needs to be (even) more central under the WHO Pandemic Agreement.Harald Schmidt - 2023 - Journal of Medical Ethics 49 (12):797-798.
    The World Health Organization (WHO) is currently in advanced stages of developing a ‘WHO convention, agreement, or other international instrument on pandemic prevention, preparedness and response’ (also known as WHO CA+, referred to below as: Pandemic Agreement). 1 Rightly, the instrument places equity at the centre. Yet, it currently also omits reference to an impactful tool to promote equity that has been adopted in an unprecedented manner during COVID-19—a set of measures known as disadvantage indices. Embedding disadvantage indices would provide (...)
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  13.  3
    Teenager and the transplant: how the case of William Verden highlights action is needed to optimise equitable access to organs for patients with impaired decision-making.Bonnie Venter, Alexander Ruck Keene & Antonia J. Cronin - 2023 - Journal of Medical Ethics 49 (12):803-807.
    In February 2022, the Court of Protection was faced with the question of whether a kidney transplant was in the best interests of William Verden. The case highlighted the legal, ethical and clinical complexities of treating potential kidney transplant patients with impaired decision-making. Above all, it exposed the potential risk of discrimination on the basis of disability when treatment decisions in relation to potential kidney recipients with impaired capacity are being made. In this paper, we draw on the Verden case (...)
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  14.  8
    With great power comes great vulnerability: an ethical analysis of psychedelics’ therapeutic mechanisms proposed by the REBUS hypothesis.Daniel Villiger & Manuel Trachsel - 2023 - Journal of Medical Ethics 49 (12):826-832.
    Psychedelics are experiencing a renaissance in mental healthcare. In recent years, more and more early phase trials on psychedelic-assisted therapy have been conducted, with promising results overall. However, ethical analyses of this rediscovered form of treatment remain rare. The present paper contributes to the ethical inquiry of psychedelic-assisted therapy by analysing the ethical implications of its therapeutic mechanisms proposed by the relaxed beliefs under psychedelics (REBUS) hypothesis. In short, the REBUS hypothesis states that psychedelics make rigid beliefs revisable by increasing (...)
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  15.  1
    Reconsidering reinterpretation: response to commentaries.Gabriel Watts & Ainsley J. Newson - 2023 - Journal of Medical Ethics 49 (12):824-825.
    The results of tests carried out using next-generation genomic sequencing (NGS) possess a peculiar and perhaps unique ‘diagnostic durability’. Unlike most other forms of testing, if genomic results or data are stored over time, then it remains possible to interrogate that information indefinitely, without having to retest the patient. Another peculiar property of genomic results is that their interpretations are subject to change within relatively short time frames. For instance, a genomic variant that is of uncertain significance (VUS) at the (...)
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  16.  2
    Is there a duty to routinely reinterpret genomic variant classifications?Gabriel Watts & Ainsley J. Newson - 2023 - Journal of Medical Ethics 49 (12):808-814.
    Multiple studies show that periodic reanalysis of genomic test results held by clinical laboratories delivers significant increases in overall diagnostic yield. However, while there is a widespread consensus that implementing routine reanalysis procedures is highly desirable, there is an equally widespread understanding that routine reanalysis of individual patient results is not presently feasible to perform for all patients. Instead, researchers, geneticists and ethicists are beginning to turn their attention to one part of reanalysis—reinterpretation of previously classified variants—as a means of (...)
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  17.  6
    Moral obligation to actively reinterpret VUS and the constraint of NGS technologies.Victor Chidi Wolemonwu - 2023 - Journal of Medical Ethics 49 (12):819-819.
    Central to Watts and Newson’s argument in their seminal paper ‘ Is there a duty to routinely reinterpret genomic variant classifications? ’ is that diagnostic laboratories are not morally obligated to actively reinterpret variants of uncertain significance (VUS) due to the superior outcomes offered by next-generation sequencing (NGS) compared with traditional methods.1 NGS technologies can identify, analyse and interpret millions of genetic variations at once. For example, ‘the use of conventional molecular assays in clinical contexts could require doing a lot (...)
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  18.  9
    Involving parents in paediatric clinical ethics committee deliberations: a current controversy.David Archard, Emma Cave & Joe Brierley - 2023 - Journal of Medical Ethics 49 (11):733-736.
    In cases where the best interests of the child are disputed or finely balanced, Clinical Ethics Committees (CECs) can provide a valuable source of advice to clinicians and trusts on the pertinent ethical dimensions. Recent judicial cases have criticised the lack of formalised guidance and inconsistency in the involvement of parents in CEC deliberations. In Manchester University NHS FT v Verden [2022], Arbuthnot J set out important procedural guidance as to how parental involvement in CEC deliberations might be managed. She (...)
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  19.  8
    Risk aversion and rational choice theory do not adequately capture complexities of medical decision-making.Zeljka Buturovic - 2023 - Journal of Medical Ethics 49 (11):761-762.
    In his paper, ‘Patients, doctors and risk attitudes’, Makins argues that doctors, when choosing a treatment for their patient, need to follow their risk profile.1 He presents a pair of fictitious diseases facing a patient who either has ‘exemplitis’, which requires no treatment or ‘caseopathy’, which is severe and disabling and for which there is a treatment with unpleasant side effects. The doctor needs to decide whether the patient should pursue the unpleasant treatment, just in case he has caseopathy. Makins (...)
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  20.  4
    Alleviating the burden of malaria with gene drive technologies? A biocentric analysis of the moral permissibility of modifying malaria mosquitoes.Nienke de Graeff, Karin Rolanda Jongsma & Annelien L. Bredenoord - 2023 - Journal of Medical Ethics 49 (11):765-771.
    Gene drive technologies (GDTs) have been proposed as a potential new way to alleviate the burden of malaria, yet have also raised ethical questions. A central ethical question regarding GDTs relates to whether it is morally permissible to intentionally modify or eradicate mosquitoes in this way and how the inherent worth of humans and non-human organisms should be factored into determining this. Existing analyses of this matter have thus far generally relied on anthropocentric and zoocentric perspectives and rejected an individualist (...)
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  21.  2
    On the elusiveness of higher-order risk attitudes.Jasper Debrabander - 2023 - Journal of Medical Ethics 49 (11):748-748.
    Makins1 formulates a deference principle which states that patients’ attitudes towards the health outcomes associated with different treatment options should drive decision-making and not physicians’ attitudes towards these health outcomes. Although this deference principle is widely agreed on, it is less obvious which role patients’ risk attitudes should play. Makins takes patients’ attitudes towards health outcomes to be sufficiently analogous to patients’ risk attitudes in order to extend his deference principle. His extended deference principle states that patients’ attitudes towards the (...)
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  22.  6
    What about the reasonableness of patients’ risk attitudes? A challenge to Makins’ antipaternalistic account.Narcyz Ghinea - 2023 - Journal of Medical Ethics 49 (11):751-752.
    Nicholas Makins proposes that doctors should take a deferential attitude towards their patients’ preferences when making decisions, and this includes their risk attitudes.1 He grounds this proposal in the principles of autonomy and beneficence. Makins appears to hold autonomy as a good in and of itself, and so for him it follows that deferring to patients must also be good. He also seems to hold that the satisfaction of personal preferences inevitably leads to improved well-being, and so deferring to patients’ (...)
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  23.  6
    Deference, beneficence and the good life.Stephen S. Hanson - 2023 - Journal of Medical Ethics 49 (11):744-745.
    Makins’s analysis of the philosophical justification of decision-making understates and so misinterprets the importance of patient values to ‘the deference principle.’ (Makins N,1, p1) He assesses autonomy and beneficence as two separate arguments in support of deferring to patient preferences, but they only work well considered together. Further, neither the constitutive nor the evidential view of beneficence fully recognises the importance of patient values to understanding the patient’s worldview, which in turn determines what risks and benefits matter most. Revising these (...)
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  24.  10
    Higher-order desires, risk attitudes and respect for autonomy.Alice Elizabeth Kelley - 2023 - Journal of Medical Ethics 49 (11):753-754.
    Nicholas Makins makes a valuable contribution to the literature on medical decision-making, highlighting the role that risk attitudes play in deliberation and subsequently arguing that, in medical choices under uncertainty, if considerations of autonomy and beneficence support deference to patient values and outcome preferences then they also support deference to patients’ attitudes to risk.1 Crucially, however, Makins suggests that it is not simply first-order risk attitudes that are the appropriate target of deference but, rather, patients’ higher-order risk attitudes. In other (...)
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  25.  4
    Rationality of irrationality: preference catering or shaping?Xiaoxu Ling & Siyuan Yan - 2023 - Journal of Medical Ethics 49 (11):759-760.
    In his featured article, Makins suggests that healthcare professionals ought to defer to patients’ higher-order attitudes towards their risk attitudes when making medical decisions under uncertainty.1 He contends that this deferential approach is consistent with widely held antipaternalistic views about medicine. While Makins offers novel, insightful and provocative perspectives, we illustrate in this commentary that the theory suffers from some weaknesses and shortcomings that limit its persuasiveness and applicability and professionals should take a cautious approach when applying it to their (...)
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  26. Patients, doctors and risk attitudes.Nicholas Makins - 2023 - Journal of Medical Ethics 49 (11):737-741.
    A lively topic of debate in decision theory over recent years concerns our understanding of the different risk attitudes exhibited by decision makers. There is ample evidence that risk-averse and risk-seeking behaviours are widespread, and a growing consensus that such behaviour is rationally permissible. In the context of clinical medicine, this matter is complicated by the fact that healthcare professionals must often make choices for the benefit of their patients, but the norms of rational choice are conventionally grounded in a (...)
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  27.  4
    Defending deference: author’s response to commentaries.Nicholas Makins - 2023 - Journal of Medical Ethics 49 (11):763-764.
    In my feature article in this issue, ‘Doctors, patients and risk attitudes’, I argue that considerations of both autonomy and beneficence support the practice of healthcare professionals deferring to their patients’ reflectively endorsed risk attitudes when making decisions under uncertainty.1 The commentaries written in response to this article present many interesting criticisms, limitations and applications of the view, and I am grateful to all of the commentators for their engagement with this topic. I cannot possibly do justice to all of (...)
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  28.  5
    Epistemic problems with mental health legislation in the doctor–patient relationship.Giles Newton-Howes, Simon Walker & Neil John Pickering - 2023 - Journal of Medical Ethics 49 (11):727-732.
    Mental health legislation that requires patients to accept ‘care’ has come under increasing scrutiny, prompted primarily by a human rights ethic. Epistemic issues in mental health have received some attention, however, less attention has been paid to the possible epistemic problems of mental health legislation existing. In this manuscript, we examine the epistemic problems that arise from the presence of such legislation, both for patients without a prior experience of being detained under such legislation and for those with this experience. (...)
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  29.  6
    Should authorship on scientific publications be treated as a right?David B. Resnik & Elise Smith - 2023 - Journal of Medical Ethics 49 (11):776-778.
    Sometimes researchers explicitly or implicitly conceive of authorship in terms of moral or ethical rights to authorship when they are dealing with authorship issues. Because treating authorship as a right can encourage unethical behaviours, such as honorary and ghost authorship, buying and selling authorship, and unfair treatment of researchers, we recommend that researchers not conceive of authorship in this way but view it as a description about contributions to research. However, we acknowledge that the arguments we have given for this (...)
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  30.  4
    Reconsidering risk attitudes: why higher-order attitudes hinder medical decision-making.Liam Francis Ryan & Jennifer Blumenthal-Barby - 2023 - Journal of Medical Ethics 49 (11):742-743.
    In his paper, ‘Patients, doctors and risk attitudes,’ Nicholas Makins1 argues that healthcare professionals should defer to a patient’s higher-order risk attitudes (ie, the risk attitudes they desire to have or endorse within themselves upon reflection) when making medical decisions. We argue against Makins’ deference to higher-order risk attitudes on the basis that (1) there are significant practical concerns regarding our ability to easily and consistently access and verify the higher-order risk attitudes of patients, (2) there is a lack of (...)
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  31.  5
    Deference to patients’ risk attitudes is contingent on medical norms.Abeezar I. Sarela - 2023 - Journal of Medical Ethics 49 (11):755-756.
    Makin argues that doctors1 should defer to each patient’s attitude to risk, over and above standard, utility-based and outcome-focussed medical decision-making models, in selecting treatment options for that patient.1 Although Makin articulates the problem as a dilemma of whether ‘to give the treatment or to withhold it’, it can be assumed that his question is whether the doctor should offer a certain treatment; because both the General Medical Council and law require doctors to engage patients in shared decision-making (SDM) and (...)
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  32.  11
    Digital bioethics: introducing new methods for the study of bioethical issues.Manuel Schneider, Effy Vayena & Alessandro Blasimme - 2023 - Journal of Medical Ethics 49 (11):783-790.
    The online space has become a digital public square, where individuals interact and share ideas on the most trivial to the most serious of matters, including discussions of controversial ethical issues in science, technology and medicine. In the last decade, new disciplines like computational social science and social data science have created methods to collect and analyse such data that have considerably expanded the scope of social science research. Empirical bioethics can benefit from the integration of such digital methods to (...)
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  33.  9
    Deception in medicine: acupuncturist cases.William Simkulet - 2023 - Journal of Medical Ethics 49 (11):781-782.
    Colgrove challenges Doug Hardman’s account of deception in medicine. Hardman contends physicians can unintentionally deceive their patients, illustrating this by way of an acupuncturist who believes what she says despite insufficient medical evidence, falling short of what Hardman believes adequate disclosure requires. Colgrove argues deception requires intent but constructs an alternative case in which an acupuncturist does not believe what he tells the patient, but purportedly lacks an intent to deceive. Here, I argue that both acupuncturists deceive, and both can (...)
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  34. Why there is no dilemma for the birth strategy: a response to Bobier and Omelianchuk.Prabhpal Singh - 2023 - Journal of Medical Ethics 49 (11):779-780.
    Bobier and Omelianchuk argue that the Birth Strategy for addressing analogies between abortion and infanticide is saddled with a dilemma. It must be accepted that non-therapeutic late-term abortions are either, impermissible, or they are not. If accepted, then the Birth Strategy is undermined. If not, then the highly unintuitive claim that non-therapeutic late-term abortions are permissible must be accepted. I argue that the moral principle employed to defend the claim that non-therapeutic late-term abortions are morally impermissible fails to do so. (...)
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  35.  10
    When uncertainty is a symptom: intolerance of uncertainty in OCD and ‘irrational’ preferences.Jared Smith - 2023 - Journal of Medical Ethics 49 (11):757-758.
    In ‘Patients, doctors and risk attitudes,’ Makins argues that, when physicians must decide for, or act on behalf of, their patients they should defer to patient risk attitudes for many of the same reasons they defer to patient values, although with a caveat: physicians should defer to the higher-order desires of patients when considering their risk attitudes. This modification of what Makins terms the ‘deference principle’ is primarily driven by potential counterexamples in which a patient has a first-order desire with (...)
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  36.  7
    Emotions and affects: the missing piece of the jigsaw puzzle of understanding risk attitudes in medical decision-making.Supriya Subramani - 2023 - Journal of Medical Ethics 49 (11):746-747.
    Nicholas Makins argues persuasively that medical decisions should be made with consideration for patients’ higher order risk attitudes.1 I will argue that an understanding of risk attitudes in medical decision-making is incomplete without critical engagement with emotions and affects (feelings associated with something good or bad). The primary aim of this commentary is to emphasise that clinical decisions are often emotionally charged, and it is crucial to engage closely with emotions and affects that shape these decisions, particularly when navigating complex (...)
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  37.  5
    Should medicine be colour blind?Mehrunisha Suleman & Zeshan Qureshi - 2023 - Journal of Medical Ethics 49 (11):725-726.
    The widely accepted understanding in contemporary discourse is that race and ethnicity fundamentally arose as social constructs devoid of inherent biological or scientific significance.1 Despite this consensus, discussions abound, including in this journal,2 regarding the extent and manner in which racial and ethnic categorisations should influence the landscape of medical research, practice and policy. In an ideal paradigm, medicine should exude an unwavering commitment to impartiality, extending care and treatment to every individual, unfettered by considerations of their racial or ethnic (...)
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  38.  2
    Autonomy requires more curiosity less deference to risk.Johnna Wellesley & Emma Tumilty - 2023 - Journal of Medical Ethics 49 (11):749-750.
    In ‘Patients, doctors and risk attitudes,’ Makins argues for ‘straightforwardly’ (Makins1 p1) extending antipaternalistic views about medical decision-making to include deferential considerations of risk attitudes that a patient might endorse. Reflecting on Makins’ important contribution to higher order attitudes in decision theory, we seek to clarify the practical applicability of his argument to specific clinical settings, namely in mental health. We argue that considering low and higher order risk preferences are not only practically difficult, but also potentially ethically fraught and (...)
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  39.  5
    Varsity Medical Ethics Debate 2019: is authoritarian government the route to good health outcomes?Azmaeen Zarif, Rhea Mittal, Ben Popham, Imogen C. Vorley, Jessy Jindal & Emily C. Morris - 2023 - Journal of Medical Ethics 49 (11):791-796.
    Authoritarian governments are characterised by political systems with concentrated and centralised power. Healthcare is a critical component of any state. Given the powers of an authoritarian regime, we consider the opportunities they possess to derive good health outcomes. The 2019 Varsity Medical Ethics Debate convened on the motion: ‘This house believes authoritarian government is the route to good health outcomes’ with Oxford as the Proposition and Cambridge as the Opposition. This article summarises and extends key arguments made during the 11th (...)
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  40.  6
    Democratising civility: Commentary on ‘McCullough LB et al: Professional virtue of civility and the responsibilities of medical educators and academic leaders’.Philip A. Berry - 2023 - Journal of Medical Ethics 49 (10):688-689.
    McCullough and colleagues draw an historical line from the writings of Percival, who found himself resolving arguments (sometimes violent) between physicians, surgeons and apothecaries, to the concept of civility as a professional virtue and duty. The authors show that civility is a prerequisite to effective cooperation, which itself underpins patient safety and positive clinical outcomes—desirable endpoints of any discussion about healthcare. They exhort academic leaders to teach, role model and reward correct behaviours.1 Why then, as a clinician manager with a (...)
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  41.  6
    Replication crisis and placebo studies: rebooting the bioethical debate.Charlotte Blease, Ben Colagiuri & Cosima Locher - 2023 - Journal of Medical Ethics 49 (10):663-669.
    A growing body of cross-cultural survey research shows high percentages of clinicians report using placebos in clinical settings. One motivation for clinicians using placebos is to help patients by capitalising on the placebo effect’s reported health benefits. This is not surprising, given that placebo studies are burgeoning, with increasing calls by researchers to ethically harness placebo effects among patients. These calls propose placebos/placebo effects offer clinically significant benefits to patients. In this paper, we argue many findings in this highly cited (...)
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  42.  5
    Incentivising civility in clinical environments.Tamara Kayali Browne & Zohar Lederman - 2023 - Journal of Medical Ethics 49 (10):683-684.
    Several months ago, an Israeli resident in emergency medicine engaged in a hunger strike to protest 26-hour shifts. His protest was part of a country-wide struggle of medical residents from all disciplines against such long shifts, arguing that they are a thing of the past, and that they harm patient care. While there is actually no evidence that long shifts harm patient outcomes, they very likely reduce civility among staff members and towards patients.1 Two kinds of strategies are possible to (...)
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  43.  3
    Global health and global governance of emerging biomedical technologies.Bryan Cwik - 2023 - Journal of Medical Ethics 49 (10):719-720.
    Global governance of emerging, disruptive biomedical technologies presents a multitude of ethical problems. The recent paper by Shoziet alraises some of these problems in the context of a discussion of what could be themostdisruptive (and most morally fraught) emerging biomedical technology—human germline genome editing. At the heart of their argument is the claim that, for something like gene editing, there is likely to be tension between the interests of specific states in crafting regulation for the technology, and disagreement about what (...)
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  44.  13
    There is no ‘I’ in team, but there are two in civil.Thomas Donaldson - 2023 - Journal of Medical Ethics 49 (10):691-691.
    McCullough et al ’s article about the professional virtue of civility makes a persuasive case that civility should be a core value in medical education, and that civility facilitates the development of organisational cultures committed to excellence in clinical and scientific reasoning.1 In particular, the negative implications of incivility on the well-being of individuals, on team-working dynamics and on patient safety, creates a strong argument that incivility from healthcare professionals is entirely unacceptable. However, in terms of professional attitudes, civility is (...)
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  45.  7
    Give incivility a chance.Ryan Essex & Lydia Mainey - 2023 - Journal of Medical Ethics 49 (10):679-680.
    Civility is a nice idea. While we find common ground with the aspirations of a civility-based professional culture in healthcare and acknowledge the potential impacts of incivility on staff and patients, we should be careful in dismissing it entirely, as McCullough et al 1 do. As we will argue below, appeals to civility, when understood alongside power, could serve to stifle and mask legitimate dissent, limiting genuine criticism and progress. Crucially, we contend that incivility itself may serve instrumental and communicative (...)
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  46.  12
    Trust and the Goldacre Review: why trusted research environments are not about trust.Mackenzie Graham, Richard Milne, Paige Fitzsimmons & Mark Sheehan - 2023 - Journal of Medical Ethics 49 (10):670-673.
    The significance of big data for driving health research and improvements in patient care is well recognised. Along with these potential benefits, however, come significant challenges, including those concerning the sharing and linkage of health and social care records. Recently, there has been a shift in attention towards a paradigm of data sharing centred on the ‘trusted research environment’ (TRE). TREs are being widely adopted by the UK’s health data initiatives including Health Data Research UK (HDR UK),1 Our Future Health2 (...)
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  47.  8
    Boundaries of civility promotion in education and leadership.Maja Graso - 2023 - Journal of Medical Ethics 49 (10):686-687.
    McCullough et al 1 confront a challenge that no organisation has fully eradicated: incivility. They emphasise that civility is not merely a matter of common decency and good conduct but also a moral imperative, an aspirational value that should be promoted and modelled by all the members of the institutions and throughout all the stages of practitioners’ careers. In their fusion of ancient wisdom and philosophical classics with their own insights on contemporary workplaces, they forward a defensible case for why (...)
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  48.  4
    How can junior doctors spontaneously pursue the professional virtues of civility? The direct role of academic leaders.Xuhao Li, Qingyue Kong, Yuanxiang Liu & Jiguo Yang - 2023 - Journal of Medical Ethics 49 (10):685-685.
    In his feature article,1 McCullough LB et al highlights the importance of civility among medical educators and academic leaders in shaping the professional habits of junior doctors. He emphasises the role of medical educators in correcting unprofessional behaviour and emphasises the need for academic leaders to motivate junior doctors to develop virtuous professional habits. The relationship between junior doctors and medical educators can be likened to that between students and teachers. Through active or passive learning from medical educators, junior doctors (...)
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  49.  17
    Withering Minds: towards a unified embodied mind theory of personal identity for understanding dementia.David M. Lyreskog - 2023 - Journal of Medical Ethics 49 (10):699-706.
    A prominent view on personal identity over time, Jeff McMahan’s ‘Embodied Mind Account’ (2002) holds that we cease to exist only once our brains can no longer sustain the basic capacity to uphold consciousness. One of the many implications of this view on identity persistence is that we continue to exist throughout even the most severe cases of dementia, until our consciousness irreversibly shuts down. In this paper, I argue that, while the most convincing of prominent accounts of personal identity (...)
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  50.  4
    Professional virtue of civility and the responsibilities of medical educators and academic leaders.Laurence B. McCullough, John Coverdale & Frank A. Chervenak - 2023 - Journal of Medical Ethics 49 (10):674-678.
    Incivility among physicians, between physicians and learners, and between physicians and nurses or other healthcare professionals has become commonplace. If allowed to continue unchecked by academic leaders and medical educators, incivility can cause personal psychological injury and seriously damage organisational culture. As such, incivility is a potent threat to professionalism. This paper uniquely draws on the history of professional ethics in medicine to provide a historically based, philosophical account of the professional virtue of civility. We use a two-step method of (...)
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  51.  7
    Professional virtue of civility: responding to commentaries.Laurence B. McCullough, John Coverdale & Frank A. Chervenak - 2023 - Journal of Medical Ethics 49 (10):692-693.
    In our ‘The Professional Virtue of Civility and the Responsibilities of Medical Educators and Academic Leaders’,1 we provided an historically based conceptual account of the professional virtue of civility and the role of leaders of academic health centres in creating and sustaining an organisational culture of professionalism that promotes civility among healthcare professionals and between medical educators and learners. We emphasised that any adequate understanding of the virtues, including professional virtues, has cognitive, affective, behavioural and social components. Some of the (...)
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  52.  5
    Physicians as citizens and the indispensability of civic virtues for professional practice.Settimio Monteverde - 2023 - Journal of Medical Ethics 49 (10):690-690.
    Incivility poses a serious threat to any healthcare system striving for effectiveness without sacrificing the requirements of humanity. Threats to civility within healthcare not only come from individual ‘bad apples’ exhibiting borderline and inacceptable behaviour, as seen in many ‘high-tech, high-risk, high-responsibility’ environments such as operating or emergency rooms.1 They may also be facilitated by ‘bad trees’ or system-immanent, poor healthcare environments.2 This may be the case when healthcare administrations, facing the challenges of political austerity, set budgetary targets that cannot (...)
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  53.  8
    Ethics briefings.Rebecca Mussell, Natalie Michaux & Molly Gray - 2023 - Journal of Medical Ethics 49 (10):721-722.
    The Nuffield Council on Bioethics (NCOB) is delighted to pick up the mantel of the Ethics briefings. For readers less familiar with the NCOB’s work, we are a leading independent policy and research centre, and the foremost bioethics body in the UK. We identify, analyse and advise on ethical issues in biomedicine and health so that decisions in these areas benefit people and society.1 Established in 1991, the NCOB has tackled a wide range of bioethics and medical ethics issues over (...)
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  54.  5
    Against abandoning the dead donor rule: reply to Smith.Adam Omelianchuk - 2023 - Journal of Medical Ethics 49 (10):715-716.
    Smith argues that death caused by transplant surgery will not harm permanently unconscious patients, because they will not suffer a setback to their interests in the context of donation. Therefore, so the argument goes, the dead donor rule can be abandoned, because requiring a death declaration before procurement does not protect any relevant interest from being thwarted. Smith contends that a virtue of his argument is that it avoids the controversies over defining and determining death. I argue that it does (...)
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  55. Egalitarianism, moral status and abortion: a reply to Miller.Joona Räsänen - 2023 - Journal of Medical Ethics 49 (10):717-718.
    Calum Miller recently argued that a commitment to a very modest form of egalitarianism—equality between non-disabled human adults—implies fetal personhood. Miller claims that the most plausible basis for human equality is in being human—an attribute which fetuses have—therefore, abortion is likely to be morally wrong. In this paper, I offer a plausible defence for the view that equality between non-disabled human adults does not imply fetal personhood. I also offer a challenge for Miller’s view.
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  56.  5
    Civility and scientific excellence: two dimensions of medical professionalism.Sabine Salloch - 2023 - Journal of Medical Ethics 49 (10):681-682.
    McCullough et al have taken up an important issue that is highly interesting from a theoretical as well as from a practical standpoint in drawing attention to (in)civility as a matter of professional ethics: As a ‘low intensity deviant behaviour’1 p3 incivility seems to widely escape the scope of professional norms as well as legal regulation and jurisdiction. At the same time, empirical evidence suggests that incivility occurs frequently in healthcare and might have an enormous negative impact on the quality (...)
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  57.  4
    Decommodifying the most important determinant of health.Arianne Shahvisi - 2023 - Journal of Medical Ethics 49 (10):661-662.
    Among the most harrowing visuals of Britain’s ongoing ‘cost of living crisis’ are the security tags that began to appear on cheese, butter, chicken, sweets and infant formula milk in 2022. A week’s worth of formula milk—the sole or main food of the vast majority of infants for the first 6 months of life—now costs between £9.39 and £15.95.1 Low-income households are entitled to a ‘Healthy Start’ welfare payment, intended to avert malnutrition among the poorest children, but the weekly allowance (...)
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  58.  3
    Amanitvam: a concept from the Bhagavad Gita applicable in medical ethics.Aditya Simha - 2023 - Journal of Medical Ethics 49 (10):723-724.
    The Bhagavad Gita is one of the most ancient, venerated and popular religious texts originating from India.1 It provides an excellent insight into the tenets of Hinduism. The Bhagavad Gita was originally a part of the Mahabharata,2 and was essentially a dialogue about ethical dilemmas and moral philosophies between a teacher (Krishna) and a disciple (Arjuna). It is considered one of the foundational and most important books in Hinduism. The text provides a synthesis of spiritualism and dharmic ideas, and this (...)
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  59.  11
    Abandoning the Dead Donor Rule.Anthony P. Smith - 2023 - Journal of Medical Ethics 49 (10):707-714.
    The Dead Donor Rule is intended to protect the public and patients, but it remains contentious. Here, I argue that we can abandon the Dead Donor Rule. Using Joel Feinberg’s account of harm, I argue that, in most cases, particularly when patients consent to being organ donors, death does not harm permanently unconscious (PUC) patients. In these cases, then, causing the death of PUC patients is not morally wrong. This undermines the strongest argument for the Dead Donor Rule—that doctors ought (...)
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  60.  10
    Non-clinical uses of antipsychotics in resource-constrained long-term care facilities: ethically justifiable as lesser of two evils?Hojjat Soofi - 2023 - Journal of Medical Ethics 49 (10):694-698.
    Residents with dementia in long-term care facilities (LTCFs) often receive antipsychotic (AP) medications without clear clinical indications. One non-clinical factor influencing the use of APs in LTCFs is low staff levels. Often, using APs is viewed and rationalised by healthcare professionals in LTCFs as a lesser evil option to manage low staff levels. This paper investigates the ethical plausibility of using APs as a lesser of two evils in resource-constrained LTCFs. I examine the practice vis-à-vis the three frequently invoked conditions (...)
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  61.  9
    Trusted research environments are definitely about trust.Paul Affleck, Jenny Westaway, Maurice Smith & Geoff Schrecker - 2023 - Journal of Medical Ethics 49 (9):656-657.
    In their highly topical paper, Grahamet alargued that Trusted Research Environments (TREs) are not actually about trust because they reduce or remove ‘…the need for trust in the use and sharing of patient health data’. We believe this is fundamentally mistaken. TREs mitigate or remove some risks, but they do not address all public concerns. In this regard, TREs provide evidence for people to decide whether the bodies holding and using their data can be trusted. TREs may make it easier (...)
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  62.  6
    Extending the ethics of episiotomy to vaginal examination: no place for opt-out consent.Rebecca Brione - 2023 - Journal of Medical Ethics 49 (9):626-627.
    van der Pijl et al 1 argue that if ‘stakes are high’ and there is ‘clear conviction by the care provider’ that it is ‘necessary’, episiotomy may be given after ‘opt-out consent’. Here I caution against the applicability of their approach to vaginal examination (VE): another routine intervention in birth to which they suggest their discussion may apply. I highlight three concerns: first, the subjective and unjustified nature of assessments of ‘necessity’; second, the inadequacy of current consent practices in relation (...)
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  63.  14
    Herd immunity, vaccination and moral obligation.Matthew Bullen, George S. Heriot & Euzebiusz Jamrozik - 2023 - Journal of Medical Ethics 49 (9):636-641.
    The public health benefits of herd immunity are often used as the justification for coercive vaccine policies. Yet, ‘herd immunity’ as a term has multiple referents, which can result in ambiguity, including regarding its role in ethical arguments. The term ‘herd immunity’ can refer to (1) the herd immunity threshold, at which models predict the decline of an epidemic; (2) the percentage of a population with immunity, whether it exceeds a given threshold or not; and/or (3) the indirect benefit afforded (...)
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  64.  4
    Medical necessity and consent for intimate procedures.Brian D. Earp & Lori Bruce - 2023 - Journal of Medical Ethics 49 (9):591-593.
    This issue considers the ethics of a healthcare provider intervening into a patient’s genitalia, whether by means of cutting or surgery or by ‘mere’ touching/examination. Authors argue that the permissibility of such actions in the absence of a relevant medical emergency does not primarily turn on third-party judgments of expected levels of physical harm versus benefit, or on related notions such as extensiveness or invasiveness; rather, it turns on the patient’s own consent. To bolster this argument, attention is drawn to (...)
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  65.  4
    We want to help: ethical challenges of medical migration and brain waste during a pandemic.Elizabeth Fenton & Kata Chillag - 2023 - Journal of Medical Ethics 49 (9):607-610.
    Health worker shortages in many countries are reaching crisis levels, exacerbated by factors associated with the COVID-19 pandemic. In New Zealand, the medical specialists union has called for a health workforce emergency to be declared, yet at the same time, many foreign-trained healthcare workers are unable to stay in the country or unable to work. While their health systems differ, countries such as New Zealand, the USA and the UK at least partially rely on international medical graduates (IMGs) to ensure (...)
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  66.  2
    TREs are still not about trust.Mackenzie Graham, Richard Milne, Paige Fitzsimmons & Mark Sheehan - 2023 - Journal of Medical Ethics 49 (9):658-660.
    In our recent paper ‘Trust and the Goldacre Review: Why TREs are not about trust’1 we argue that trusted research environments (TREs) reduce the need for trust in the use and sharing of health data, and that referring to these data storage systems as ‘trusted’ raises a number of concerns. Recent replies to our paper have raised several objections to this argument. In this reply, we seek to build on the arguments presented in our original paper, address some of the (...)
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  67.  7
    Consent and episiotomies: do not let the perfect be the enemy of the good.Elselijn Kingma, Marit van der Pijl, Corine Verhoeven, Martine Hollander & Ank de Jonge - 2023 - Journal of Medical Ethics 49 (9):632-633.
    We read commentaries on our feature article ‘The ethics of consent during labour and birth: episiotomies’1 with gratitude and interest. Nearly all commenting authors agree that consent for in-labour procedures is necessary and ideally given at the point of intervening. Both Shalowitz & Ralston and Stirrat note that this is already required by professional statements and guidelines in the USA2 and UK3, respectively, but also note that practice does not yet conform. The Americans authors helpfully emphasise the importance of multilevel (...)
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  68.  7
    Setting a human rights and legal framework around ‘the ethics of consent during labour and birth: episiotomies’.Bashi Kumar-Hazard & Hannah Grace Dahlen - 2023 - Journal of Medical Ethics 49 (9):634-635.
    We commend the authors for their comprehensive discussion on consent and episiotomies.1 They correctly observe that informed consent for all proposed interventions in maternity care is always necessary. The claim that consent for maternity health services does not always have to be fully informed or explicit, however, is erroneous. We are especially concerned with, and surprised by, the endorsement of ‘opt-out consent’. ‘Opt-out consent’ (a.k.a. substitute decision making) is already standard practice in maternity healthcare, with obstetric violence a normalised response (...)
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  69.  2
    Paediatric surgeons’ current knowledge and practices of obtaining assent from adolescents for elective reconstructive procedures.Krista Lai, Nathan S. Rubalcava, Erica M. Weidler & Kathleen van Leeuwen - 2023 - Journal of Medical Ethics 49 (9):602-606.
    PurposeAdolescents develop their decision-making ability as they transition from childhood to adulthood. Participation in their medical care should be encouraged through obtaining assent, as recommended by the American Academy of Pediatrics (AAP). In this research, we aim to define the current knowledge of AAP recommendations and surgeon practices regarding assent for elective reconstructive procedures.MethodsAn anonymous electronic survey was distributed to North American paediatric surgeons and fellows through the American Pediatric Surgical Association (n=1353).ResultsIn total, 220 surgeons and trainees responded (16.3%). Fifty (...)
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  70.  4
    Birth, trust and consent: reasonable mistrust and trauma-informed remedies.Elizabeth Lanphier & Leah Lomotey-Nakon - 2023 - Journal of Medical Ethics 49 (9):624-625.
    In ‘The ethics of consent during labour and birth: episiotomies,’ van der Pijl et al 1 respond to the prevalence of unconsented procedures during labour, proposing a set of necessary features for adequate consent to episiotomy. Their model emphasises information sharing, value exploration and trust between a pregnant person and their healthcare provider(s). While focused on consent to episiotomy, van der Pijl et al contend their approach may be applicable to consent for other procedures during labour and beyond pregnancy-related care. (...)
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  71.  9
    Loneliness at the age of COVID-19.Zohar Lederman - 2023 - Journal of Medical Ethics 49 (9):649-654.
    Loneliness has been a major concern for philosophers, poets and psychologists for centuries. In the past several decades, it has concerned clinicians and public health practitioners as well. The research on loneliness is urgent for several reasons. First, loneliness has been and still is extremely ubiquitous, potentially affecting people across multiple demographics and geographical areas. Second, it is philosophically intriguing, and its analysis delves into different branches of philosophy including phenomenology, existentialism, philosophy of mind, etc. Third, empirical research has shown (...)
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  72.  4
    Consent and the problem of epistemic injustice in obstetric care.Ji-Young Lee - 2023 - Journal of Medical Ethics 49 (9):618-619.
    An episiotomy is ‘an intrapartum procedure that involves an incision to enlarge the vaginal orifice,’1 and is primarily justified as a way to prevent higher degrees of perineal trauma or to facilitate a faster birth in cases of suspected fetal distress. Yet the effectiveness of episiotomies is controversial, and many professional bodies recommend against the routine use of episiotomies. In any case, unconsented episiotomies are alarmingly common, and some care providers in obstetric settings often fail to see consent as necessary (...)
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  73.  3
    Capacity assessment during labour and the role of opt-out consent.Kelsey Mumford - 2023 - Journal of Medical Ethics 49 (9):620-621.
    The authors of the feature article argue against implied consent in all episiotomy cases, but allow that opt-out consent might be appropriate in limited circumstances.1 However, they do not indicate how clinicians should assess whether the pregnant person is capable of consenting in this way during an obstetric emergency. This commentary will focus on how capacity should be determined during these circumstances, suggest next steps for clinicians if capacity is deemed uncertain or absent, and discuss the appropriate role for opt-out (...)
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  74.  7
    Episiotomies and the ethics of consent during labour and birth: thinking beyond the existing consent framework.Anna Nelson & Beverley Clough - 2023 - Journal of Medical Ethics 49 (9):622-623.
    We agree with van der Pijl et al that the question of how to ensure consent is obtained for procedures which occur during labour and childbirth is vitally important, and worthy of greater attention.1 However, we argue that the modified opt-out approach to consent outlined in their paper may not do enough to protect the choice and agency of birthing people. Moreover, while their approach reflects a pragmatic attempt to facilitate legal clarity and certainty in this context, this is not (...)
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  75.  9
    Expanding health justice to consider the environment: how can bioethics avoid reinforcing epistemic injustice?Bridget Pratt - 2023 - Journal of Medical Ethics 49 (9):642-648.
    We are in the midst of a global crisis of climate change and environmental degradation to which the healthcare sector directly contributes. Yet conceptions of health justice have little to say about the environment. They purport societies should ensure adequate health for their populations but fail to require doing so in ways that avoid environmental harm or injustice. We need to expand our understanding of health justice to consider the environment and do so without reinforcing the epistemic injustice inherent in (...)
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  76.  1
    Safeguards for procedural consent in obstetric care.David I. Shalowitz & Steven J. Ralston - 2023 - Journal of Medical Ethics 49 (9):628-629.
    Van der Pijl et al outline data suggesting an alarmingly high incidence of violation of the bodily integrity of patients in labour, including episiotomies performed without patients’ consent, or over their explicit objection.1 Similar data have been reported from the USA and Canada.2 The authors appropriately conclude that explicit consent is required at the time of all invasive obstetrical procedures, including episiotomy. Commonsense adjustments to the duration and detail of consent under conditions of clinical urgency are appropriate and should be (...)
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  77.  2
    Informed decision-making in labour: action required.Gordon M. Stirrat - 2023 - Journal of Medical Ethics 49 (9):630-631.
    The timely feature article by van der Pijl et al 1 highlights not only the widespread frequency with which unconsented episiotomies and other procedures during labour are reported by women but also that there is hardly any discussion in the literature on the ethics of consent for procedures in labour. Those national and international bodies with responsibility for midwifery and obstetric practice need not only to recognise but also act to remedy this unacceptable situation. The studies quoted used the recollection (...)
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  78.  2
    ‘How is it possible that at times we can be physicians and at times assistants in suicide?’ Attitudes and experiences of palliative care physicians in respect of the current legal situation of suicide assistance in Switzerland.Martyna Tomczyk, Roberto Andorno & Ralf J. Jox - 2023 - Journal of Medical Ethics 49 (9):594-601.
    IntroductionSwitzerland lacks specific legal regulation of assistance in suicide. The practice has, however, developed since the 1980s as a consequence of a gap in the Swiss Criminal Code and is performed by private right-to-die organisations. Traditionally, assistance in suicide is considered contrary to the philosophy of palliative care. Nonetheless, Swiss palliative care physicians regularly receive patient requests for suicide assistance. Their attitudes towards the legal regulations of this practice and their experience in this context remain unclear.ObjectivesOur study aimed to explore (...)
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  79.  9
    The ethics of consent during labour and birth: episiotomies.Marit van der Pijl, Corine Verhoeven, Martine Hollander, Ank de Jonge & Elselijn Kingma - 2023 - Journal of Medical Ethics 49 (9):611-617.
    Unconsented episiotomies and other procedures during labour are commonly reported by women in several countries, and often highlighted in birth activism. Yet, forced caesarean sections aside, the ethics of consent during labour has received little attention. Focusing on episiotomies, this paper addresses whether and how consent in labour should be obtained. We briefly review the rationale for informed consent, distinguishing its intrinsic and instrumental relevance for respecting autonomy. We also emphasise two non-explicit ways of giving consent: implied and opt-out consent. (...)
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  80.  10
    Using meconium to establish prenatal alcohol exposure in the UK: ethical, legal and social considerations.Rachel Arkell & Ellie Lee - 2023 - Journal of Medical Ethics 49 (8):531-535.
    An expanding policy framework aimed at monitoring alcohol consumption during pregnancy has emerged. The primary justification is prevention of harm from what is termed ‘prenatal alcohol exposure’ (PAE), by enabling more extensive diagnosis of the disability labelled fetal alcohol spectrum disorder (FASD). Here we focus on proposals to include biomarkers as a PAE ‘screening tool’, specifically those found in meconium (the first newborn excrement), which are discussed as an ‘objective’ measure of PAE.We ask the overarching question, ‘Can routine screening of (...)
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  81.  2
    Ethics of speculation.Jennifer Blumenthal-Barby - 2023 - Journal of Medical Ethics 49 (8):525-525.
    In an April 2023 article in JAMA Pediatrics, ‘Life Support System for the Fetonate and the Ethics of Speculation’, authors De Bie, Flake and Feudtner critique bioethicists for practising what they call ‘speculative ethics’. The authors refer to a 2017 article that they published on the Extra-uterine Environment of Neonatal Development (EXTEND) system. This system was able to keep fetonatal (newborn, but in a fetal physiological state) lambs alive outside of the parent lamb’s womb for 4 weeks. The article has (...)
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  82.  7
    Epistemic virtues of harnessing rigorous machine learning systems in ethically sensitive domains.Thomas F. Burns - 2023 - Journal of Medical Ethics 49 (8):547-548.
    Some physicians, in their care of patients at risk of misusing opioids, use machine learning (ML)-based prediction drug monitoring programmes (PDMPs) to guide their decision making in the prescription of opioids. This can cause a conflict: a PDMP Score can indicate a patient is at a high risk of opioid abuse while a patient expressly reports oppositely. The prescriber is then left to balance the credibility and trust of the patient with the PDMP Score. Pozzi1 argues that a prescriber who (...)
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  83.  7
    Ubuntu as a complementary perspective for addressing epistemic (in)justice in medical machine learning.Brandon Ferlito & Michiel De Proost - 2023 - Journal of Medical Ethics 49 (8):545-546.
    Pozzi1 has thoroughly analysed testimonial injustices in the automated Prediction Drug Monitoring Programmes (PDMPs) case. Although Pozzi1 suggests that ‘the shift from an interpersonal to a structural dimension … bears a significant moral component’, her topical investigation does not further conceptualise the type of collective knowledge practices necessary to achieve epistemic justice. As Pozzi1 concludes: ‘this paper shows the limitations of systems such as automated PDMPs, it does not provide possible solutions’. In this commentary, we propose that an Ubuntu perspective—which, (...)
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  84.  3
    ‘Can I trust my patient?’ Machine Learning support for predicting patient behaviour.Florian Funer & Sabine Salloch - 2023 - Journal of Medical Ethics 49 (8):543-544.
    Giorgia Pozzi’s feature article1 on the risks of testimonial injustice when using automated prediction drug monitoring programmes (PDMPs) turns the spotlight on a pressing and well-known clinical problem: physicians’ challenges to predict patient behaviour, so that treatment decisions can be made based on this information, despite any fallibility. Currently, as one possible way to improve prognostic assessments of patient behaviour, Machine Learning-driven clinical decision support systems (ML-CDSS) are being developed and deployed. To make her point, Pozzi discusses ML-CDSSs that are (...)
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  85.  6
    Analysis of the institutional landscape and proliferation of proposals for global vaccine equity for COVID-19: too many cooks or too many recipes?Susi Geiger & Aisling McMahon - 2023 - Journal of Medical Ethics 49 (8):583-590.
    This article outlines and compares current and proposed global institutional mechanisms to increase equitable access to COVID-19 vaccines, focusing on their institutional and operational complementarities and overlaps. It specifically considers the World Health Organization's (WHO’s) COVAX (COVID-19 Vaccines Global Access) model as part of the Access to COVID-19 Tools Accelerator (ACT-A) initiative, the WHO’s COVID-19 Technology Access Pool (C-TAP) initiative, the proposed TRIPS (Trade-Related Aspects of Intellectual Property Agreement) intellectual property waiver and other proposed WHO and World Trade Organization technology (...)
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  86.  5
    Testimonial injustice in medical machine learning: a perspective from psychiatry.George Gillett - 2023 - Journal of Medical Ethics 49 (8):541-542.
    Pozzi provides a thought-provoking account of how machine-learning clinical prediction models (such as Prediction Drug Monitoring Programmes (PDMPs)) may exacerbate testimonial injustice.1 In this response, I generalise Pozzi’s concerns about PDMPs to traditional models of clinical practice and question the claim that inaccurate clinicians are necessarily preferential to inaccurate machine-learning models. I then explore Pozzi’s concern that such models may deprive patients of a right to ‘convey information’. I suggest that machine-learning tools may be used to enhance, rather than frustrate, (...)
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  87.  12
    Ethical problems with kindness in healthcare.Edwin Jesudason - 2023 - Journal of Medical Ethics 49 (8):558-562.
    Kindness and its kindred concepts, compassion and empathy, are strongly valued in healthcare. But at the same time, health systems all too often treat people unfairly and cause harm. Is it possible that kindness actually contributes to these unkind outcomes? Here, I argue that, despite its attractive qualities, kindness can pose and perpetuate systemic problems in healthcare. By being discretionary, it can interfere with justice and non-maleficence. It can be problematic for autonomy too. Using the principalist lens allows us to (...)
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  88.  67
    Externalist Argument Against Medical Assistance in Dying for Psychiatric Illness.Hane Htut Maung - 2023 - Journal of Medical Ethics 49 (8):553-557.
    Medical assistance in dying, which includes voluntary euthanasia and assisted suicide, is legally permissible in a number of jurisdictions, including the Netherlands, Belgium, Switzerland and Canada. Although medical assistance in dying is most commonly provided for suffering associated with terminal somatic illness, some jurisdictions have also offered it for severe and irremediable psychiatric illness. Meanwhile, recent work in the philosophy of psychiatry has led to a renewed understanding of psychiatric illness that emphasises the role of the relation between the person (...)
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  89.  7
    Intimate relationships in residential aged care: what factors influence staff decisions to intervene?Linda McAuliffe, Deirdre Fetherstonhaugh & Maggie Syme - 2023 - Journal of Medical Ethics 49 (8):526-530.
    Intimacy contributes to our well-being and extends into older age, despite cognitive or physical impairment. However, the ability to enjoy intimacy and express sexuality is often compromised—or even controlled—when one moves into residential aged care. The aim of this study was to identify what factors influence senior residential aged care staff when they make decisions regarding resident intimate relationships and sexual expression. The study used vignette methodology and a postal survey to explore reactions to a fictionalised case study of a (...)
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  90.  13
    Evidence, ethics and the promise of artificial intelligence in psychiatry.Melissa McCradden, Katrina Hui & Daniel Z. Buchman - 2023 - Journal of Medical Ethics 49 (8):573-579.
    Researchers are studying how artificial intelligence (AI) can be used to better detect, prognosticate and subgroup diseases. The idea that AI might advance medicine’s understanding of biological categories of psychiatric disorders, as well as provide better treatments, is appealing given the historical challenges with prediction, diagnosis and treatment in psychiatry. Given the power of AI to analyse vast amounts of information, some clinicians may feel obligated to align their clinical judgements with the outputs of the AI system. However, a potential (...)
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  91.  89
    Human equality arguments against abortion.Calum Miller - 2023 - Journal of Medical Ethics 49 (8):569-572.
    In this paper, I argue that a commitment to a very modest form of egalitarianism—equality between non-disabled human adults—implies fetal personhood. Since the most plausible bases for human value are in being human, or in a gradated property, and since the latter of which implies an inequality between non-disabled adult humans, I conclude that the most plausible basis for human equality is in being human—an attribute which fetuses have.
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  92.  5
    PDMP causes more than just testimonial injustice.Tina Nguyen - 2023 - Journal of Medical Ethics 49 (8):549-550.
    In the article ‘Testimonial injustice in medical machine learning’, Pozzi argues that the prescription drug monitoring programme (PDMP) leads to testimonial injustice as physicians are more inclined to trust the PDMP’s risk scores over the patient’s own account of their medication history.1 Pozzi further develops this argument by discussing how credibility shifts from patients to machine learning (ML) systems that are supposedly neutral. As a result, a sense of distrust is now formed between patients and physicians. While there are merits (...)
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  93.  5
    Further remarks on testimonial injustice in medical machine learning: a response to commentaries.Giorgia Pozzi - 2023 - Journal of Medical Ethics 49 (8):551-552.
    In my paper entitled ‘Testimonial injustice in medical machine learning’,1 I argued that machine learning (ML)-based Prediction Drug Monitoring Programmes (PDMPs) could infringe on patients’ epistemic and moral standing inflicting a testimonial injustice.2 I am very grateful for all the comments the paper received, some of which expand on it while others take a more critical view. This response addresses two objections raised to my consideration of ML-induced testimonial injustice in order to clarify the position taken in the paper. The (...)
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  94.  12
    Testimonial injustice in medical machine learning.Giorgia Pozzi - 2023 - Journal of Medical Ethics 49 (8):536-540.
    Machine learning (ML) systems play an increasingly relevant role in medicine and healthcare. As their applications move ever closer to patient care and cure in clinical settings, ethical concerns about the responsibility of their use come to the fore. I analyse an aspect of responsible ML use that bears not only an ethical but also a significant epistemic dimension. I focus on ML systems’ role in mediating patient–physician relations. I thereby consider how ML systems may silence patients’ voices and relativise (...)
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  95.  5
    Guest editorial: Care not criminalisation; reform of British abortion law is long overdue.Sally Sheldon & Jonathan Lord - 2023 - Journal of Medical Ethics 49 (8):523-524.
    Megan1 is a young teenage patient who suffered a stillbirth at 28 weeks, leading to a year long police investigation dropped only after postmortem tests found that her pregnancy was lost due to natural causes. The stress of the investigation and her isolation from friends and support network following the seizure of her mobile and laptop compounded the trauma of the stillbirth, leaving her requiring emergency psychiatric care. Aisha1 is a vulnerable patient who suffered a premature delivery, having experienced similar (...)
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  96.  3
    Response to commentaries: ‘autonomy-based criticisms of the patient preference predictor’.David Wasserman & David Wendler - 2023 - Journal of Medical Ethics 49 (8):580-582.
    The authors respond to four JME commentaries on their Feature Article, ‘Autonomy-based criticisms of the patient preference predictor’.
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  97.  5
    Dirty work: well-intentioned mental health workers cannot ameliorate harms in offshore detention.Janine Penfield Winters, Fiona Owens & Elisif Winters - 2023 - Journal of Medical Ethics 49 (8):563-568.
    Professional providers of mental health services are motivated to help people, including, or especially, vulnerable people. We analyse the ethical implications of mental health providers accepting employment at detention centres that operate out of the normal regulatory structure of the modern state. Specifically, we examine tensions and moral harms experienced by providers at the Australian immigration detention centre on the island of Nauru. Australia has adopted indefinite offshore detention for asylum-seekers arriving by boat as part of a deterrence strategy that (...)
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  98.  6
    Can identity-relative paternalism shift the focus from the principle of autonomy?Cressida Auckland - 2023 - Journal of Medical Ethics 49 (7):451-452.
    Mill’s proscription that ‘the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others’ has become almost axiomatic in bioethics. 1 Bolstered by the rise of patient autonomy during the mid-20th century, Millian conceptions of freedom have become so embedded in bioethical theory, that attempts to justify paternalism have typically involved making one of two claims. Either, they have involved refuting the significance of autonomy as (...)
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  99.  47
    An autonomy-based approach to assisted suicide: a way to avoid the expressivist objection against assisted dying laws.Esther Braun - 2023 - Journal of Medical Ethics 49 (7):497-501.
    In several jurisdictions, irremediable suffering from a medical condition is a legal requirement for access to assisted dying. According to the expressivist objection, allowing assisted dying for a specific group of persons, such as those with irremediable medical conditions, expresses the judgment that their lives are not worth living. While the expressivist objection has often been used to argue that assisted dying should not be legalised, I show that there is an alternative solution available to its proponents. An autonomy-based approach (...)
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  100.  4
    Assent: going beyond acknowledgement for fair inclusion.Alice Cavolo & Chris Gastmans - 2023 - Journal of Medical Ethics 49 (7):487-488.
    In her article Reification and assent in research involving those who lack capacity, Anna Smajdor shows how excluding adults with impairments of capacity (AWICs) to protect them from the risks of medical research has the paradoxical effect of harming them by reifying them.1 While the medical risks of excluding vulnerable populations in general from medical research are well known, the main risk being the creation of therapeutic orphans, the risk of reifying these populations is less discussed. Hence, we commend Smajdor (...)
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  101.  11
    Deception, intention and clinical practice.Nicholas Colgrove - 2023 - Journal of Medical Ethics 49 (7):510-512.
    Regarding the appropriateness of deception in clinical practice, two (apparently conflicting) claims are often emphasised. First, that ‘clinicians should not deceive their patients.’ Second, that deception is sometimes ‘in a patient’s best interest.’ Recently, Hardman has worked towards resolving this conflict by exploring ways in which deceptive and non-deceptive practices extend beyond consideration of patients’ beliefs. In short, some practices only seem deceptive because of the (common) assumption that non-deceptive care is solely aimed at fostering true beliefs. Non-deceptive care, however, (...)
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  102.  14
    The age limit for euthanasia requests in the Netherlands: a Delphi study among paediatric experts.Sedona Celine de Keijzer, Guy Widdershoven, A. A. Eduard Verhagen & H. Roeline Pasman - 2023 - Journal of Medical Ethics 49 (7):458-464.
    BackgroundThe Dutch Euthanasia Act applies to patients 12 years and older, which makes euthanasia for minors younger than 12 legally impossible. The issue under discussion specifically regards the capacity of minors to request euthanasia.ObjectiveGain insight in paediatric experts’ views about which criteria are important to assess capacity, from what age minors can meet those criteria, what an assessment procedure should look like and what role parents should have.MethodsA Delphi study with 16 experts (paediatricians, paediatric nurses and paediatric psychologists) who work (...)
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  103.  5
    Data for sale: trust, confidence and sharing health data with commercial companies.Mackenzie Graham - 2023 - Journal of Medical Ethics 49 (7):515-522.
    Powered by ‘big health data’ and enormous gains in computing power, artificial intelligence and related technologies are already changing the healthcare landscape. Harnessing the potential of these technologies will necessitate partnerships between health institutions and commercial companies, particularly as it relates to sharing health data. The need for commercial companies to be trustworthy users of data has been argued to be critical to the success of this endeavour. I argue that this approach is mistaken. Our interactions with commercial companies need (...)
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  104.  7
    Pretending to care.Doug Hardman - 2023 - Journal of Medical Ethics 49 (7):506-509.
    On one hand, it is commonly accepted that clinicians should not deceive their patients, yet on the other there are many instances in which deception could be in a patient’s best interest. In this paper, I propose that this conflict is in part driven by a narrow conception of deception as contingent on belief. I argue that we cannot equate non-deceptive care solely with introducing or sustaining a patient’s true belief about their condition or treatment, because there are many instances (...)
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  105.  6
    Unintentional deception still deceives.Doug Hardman - 2023 - Journal of Medical Ethics 49 (7):513-514.
    In my recent article,Pretending to care, I argue that a better understanding of non-doxastic attitudes could improve our understanding of deception in clinical practice. In an insightful and well-argued response, Colgrove highlights three problems with my account. For the sake of brevity, in this reply I focus on the first: that my definition of deception is implausible because it does not involve intention. Although I concede that my initial broad definition needs modification, I argue that it should not be modified (...)
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  106.  4
    Equipoise, standard of care and consent: responding to the authorisation of new COVID-19 treatments in randomised controlled trials.Soren Holm, Jonathan Lewis & Rafael Dal-Ré - 2023 - Journal of Medical Ethics 49 (7):465-470.
    In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of molnupiravir, a novel antiviral medicine aimed (...)
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  107.  9
    Leveling (down) the playing field: performance diminishments and fairness in sport.Sebastian Jon Holmen, Thomas Søbirk Petersen & Jesper Ryberg - 2023 - Journal of Medical Ethics 49 (7):502-505.
    The 2018 eligibility regulation for female competitors with differences of sexual development (DSD) issued by World Athletics requires competitors with DSD with blood testosterone levels at or above 5 nmol/L and sufficient androgen sensitivity to be excluded from competition in certain events unless they reduce the level of testosterone in their blood. This paper formalises and then critically assesses the fairness-based argument offered in support of this regulation by the federation. It argues that it is unclear how the biological advantage (...)
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  108. What should recognition entail? Responding to the reification of autonomy and vulnerability in medical research.Jonathan Lewis & Soren Holm - 2023 - Journal of Medical Ethics 49 (7):491-492.
    Smajdor argues that “recognition” is the solution to the “reifying attitude” that results from “the urge to protect ‘vulnerable’ people through exclusion from research”. Drawing on theories of reification, we argue that it is the concepts of autonomy and vulnerability themselves that have been reified, resulting in the impoverishment of approaches to autonomy at law and in research ethics. Overcoming such reification demands a deeper consideration of the grounds on which vulnerable individuals are owed recognition and thereby the forms such (...)
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  109.  6
    Preserving women’s reproductive autonomy while promoting the rights of people with disabilities?: the case of Heidi Crowter and Maire Lea-Wilson in the light of NIPT debates in England, France and Germany.Adeline Perrot & Ruth Horn - 2023 - Journal of Medical Ethics 49 (7):471-473.
    On July 2021, the UK High Court of Justice heard the Case CO/2066/2020 on the application of Heidi Crowter who lives with Down’s syndrome, and Máire Lea-Wilson whose son Aidan has Down’s syndrome. Crowter and Lea-Wilson, with the support of the disability rights campaign, ‘Don’t Screen Us Out’, have been taking legal action against the Secretary of State for Health and Social Care (the UK Government) for a review of the 1967 Abortion Act: the removal of section 1(1)(d) making termination (...)
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  110.  2
    Vulnerable person investigation plan (VIP) to optimise inclusion in clinical trials.Ilana C. Raburn, Eline M. Bunnik & Antonia J. Cronin - 2023 - Journal of Medical Ethics 49 (7):489-490.
    Smajdor addresses the problem of inferior clinical outcomes among adults with impairments of capacity to give informed consent (AWIC). She notes that AWIC are generally excluded from clinical trials to protect them against harms and avoid exploitation and claims there is a causal link between involvement in clinical trials and favourable outcomes. She argues, given this link, that we should increase AWIC representation in clinical trials and can justifiably do so by recognising the capacity of AWIC to assent. AWIC form (...)
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  111.  4
    Assent and vulnerability in patients who lack capacity.Christopher A. Riddle - 2023 - Journal of Medical Ethics 49 (7):485-486.
    Smajdor’s Reification and Assent in Research Involving Those Who lack Capacity claims, among other things, that ‘adults who cannot give informed consent may nevertheless have the ability to assent and dissent, and that these capacities are morally important in the context of research’.1 More pointedly, she suggests we can rely upon Gillick competence, or that ‘it is worth thinking about why the same trajectory [as children] has not been evident in the context of [adults with impairments of capacity to give (...)
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  112.  6
    Watching the watchmen: changing tides in the oversight of medical assistance in dying.Sean Riley - 2023 - Journal of Medical Ethics 49 (7):453-457.
    The recent wave of medical assistance in dying legalisation raises questions about proper oversight of the practice as new systems for data collection, case assessment and public reporting emerge. Newer systems, such as in Spain, New Zealand and Colombia, are eschewing the retrospective approach used for case assessment in older systems, particularly those in the Netherlands, Belgium and the USA, in favour of an approach requiring more extensive review prior to the procedure. This shift aims to increase compliance with each (...)
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  113.  7
    Reification and assent in research involving those who lack capacity.Anna Smajdor - 2023 - Journal of Medical Ethics 49 (7):474-480.
    In applied ethics, and in medical treatment and research, the question of how we should treat others is a central problem. In this paper, I address the ethical role of assent in research involving human beings who lack capacity. I start by thinking about why consent is ethically important, and consider what happens when consent is not possible. Drawing on the work of the German philosopher Honneth, I discuss the concept of reification—a phenomenon that manifests itself when we fail to (...)
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  114.  8
    Assent and reification: a response to the commentators.Anna Smajdor - 2023 - Journal of Medical Ethics 49 (7):495-496.
    My paper on assent and reification in research involving adults with impairments of capacity and/or communication (AWIC)1 drew many thoughtful and insightful responses. I am grateful to all who submitted commentaries. Most agreed in principle that AWIC could be better represented in medical research. However, several commentators felt that further clarification was needed in terms of what assent is and how it should be obtained and operationalised.2 I fully agree that if increased representation of AWIC is to come about through (...)
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  115. Call for moral recognition as part of paediatric assent.Jared Smith & Jennifer Blumenthal-Barby - 2023 - Journal of Medical Ethics 49 (7):481-482.
    In ‘Reification and Assent in Research Involving Those Who Lack Capacity’, Smajdor argues that adults with impaired capacity to grant informed consent (AWIC) are often excluded from participating in biomedical research because they cannot provide informed consent, leading to decreased chances AWIC will benefit from such research. Smajdor uses Honneth’s concept of reification to propose that securing assent (rather than consent) in cases involving AWIC offers patients moral recognition that is not tied to their capacities. Assent provides this recognition by (...)
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  116.  2
    Assent to research by the formerly competent: necessary and sufficient?Hojjat Soofi - 2023 - Journal of Medical Ethics 49 (7):483-484.
    Anna Smajdor offers a fresh perspective on why assent is morally required in research practices involving people who (are considered to) lack the capacity to consent.1 Smajdor holds that seeking (and documenting) assent can be a mechanism to recognise those who (are considered to) lack the capacity to consent as participants ‘in our moral sphere’.1 Smajdor suggests that this approach can function as a counter to the ‘reifying’ attitudes (often) taken towards people who (are judged to) lack the capacity to (...)
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  117.  2
    Understanding the autonomy of adults with impaired capacity through dialogue.Alistair Wardrope, Simon Bell, Daniel Blackburn, Jon Dickson, Markus Reuber & Traci Walker - 2023 - Journal of Medical Ethics 49 (7):493-494.
    Smajdor invites welcome interrogation of the distance between our philosophical justifications of how we engage people in decisions about healthcare or research, and the ways we do so.1 She notes the implicit elision made between autonomy and informed consent, and argues the latter alone cannot secure the former, proposing a more flexible approach. As researchers working with people with dementia (PwD), we share Smajdor’s reservations. We argue that an autonomy worthy of respect requires not just decision-making capacity, but also authenticity; (...)
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  118.  3
    Engagement without entanglement: a framework for non-sexual patient–physician boundaries.Jacob M. Appel - 2023 - Journal of Medical Ethics 49 (6):383-388.
    The integrity of the patient–physician relationship depends on maintaining professional boundaries. While ethicists and professional organisations have devoted significant consideration to the subject of sexual boundary transgressions, the subject of non-sexual boundaries, especially outside the mental health setting, has been largely neglected. While professional organisations may offer guidance on specific subjects, such as accepting gifts or treating relatives, as well as general guidance on transparency and conflict of interest, what is missing is a principle-based method that providers can use to (...)
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  119.  22
    Identity-Relative Paternalism and Allowing Harm to Others.David Birks - 2023 - Journal of Medical Ethics 49 (6):411-412.
    Dominic Wilkinson’s defence of identity-relative paternalism raises many important issues that are well worth considering. In this short paper, I will argue that there could be two important differences between the first-party and third-party cases that Wilkinson discusses, namely, a difference in associative duties and how the decision relates to the decision maker’s own autonomous life. This could mean that identity-relative paternalism is impermissible in a greater number of cases than he suggests.
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  120.  9
    Identity-relative paternalism fails to achieve its apparent goal.Esther Braun - 2023 - Journal of Medical Ethics 49 (6):413-414.
    In a recent article, Wilkinson puts forward the notion of identity-relative paternalism. According to Wilkinson’s final formulation of this principle, ‘[i]ndividuals should be prevented from doing to future selves (where there are weakened prudential unity relations between the current and future self) what it would be justified to prevent them from doing to others’.1 In medical ethics, it is usually assumed that hard paternalism, that is, acting against a competent person’s wishes for their own benefit, is not justified. According to (...)
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  121.  5
    Chronicity: a key concept to deliver ethically driven chronic care.Francisca Stutzin Donoso - 2023 - Journal of Medical Ethics 49 (6):447-448.
    Chronic diseases are the main disease burden worldwide, leading to premature deaths and poor individual and population health outcomes. Although modern medicine has made significant progress in developing effective treatments, only around 50% of people follow long-term treatment recommendations in high-income countries and presumably even less in low-income and middle-income countries.1 Health outcomes for chronic diseases follow a social gradient across socioeconomic groups, suggesting that the 50% adherence rate distributes unequally across social groups, affecting those who live in disadvantage the (...)
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  122.  5
    Medical choices and changing selves.Rebecca Dresser - 2023 - Journal of Medical Ethics 49 (6):403-403.
    In The Harm Principle, Personal Identity and Identity-Relative Paternalism,1 Wilkinson offers a thoughtful argument about medical decision-making and Derek Parfit’s reductionist account of personal identity. I agree that Parfit’s account can contribute to the ethical analysis of patients’ choices. My own work in this area emphasises challenges the reductionist account presents to conventional understanding of advance treatment directives, particularly in cases involving people with dementia.2 I have also urged people making directives to consider the harm their directives could impose on (...)
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  123.  12
    Prescribing safe supply: ethical considerations for clinicians.Katherine Duthie, Eric Mathison, Helgi Eyford & S. Monty Ghosh - 2023 - Journal of Medical Ethics 49 (6):377-382.
    The COVID-19 pandemic has exacerbated the drug poisoning epidemic in a number of ways: individuals use alone more often, there is decreased access to harm reduction services and there has been an increase in the toxicity of the unregulated drug supply. In response to the crisis, clinicians, policy makers and people who use drugs have been seeking ways to prevent the worst harms of unregulated opioid use. One prominent idea is safe supply. One form of safe supply enlists clinicians to (...)
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  124.  6
    Bringing context into ethical discussion: what, when and who?Lucy Frith - 2023 - Journal of Medical Ethics 49 (6):375-376.
    Arguably one of the strengths of the discipline of medical ethics is its close attention to the context in which ethical dilemmas, questions and issues play out. As a discipline that is concerned with helping and supporting practitioners, policy-makers and the public to address the ethical aspects of healthcare provision and practice in the best way they can, context is crucially important. As McMillian puts it, ‘ethics should be grounded’ in the practical realities of the situation.1 What, where and who (...)
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  125.  5
    Does identity-relative paternalism prohibit (future) self-sacrifice? A reply to Wilkinson.Charlotte Garstman, Sterre de Jong & Justin Bernstein - 2023 - Journal of Medical Ethics 49 (6):406-408.
    Paternalism has attracted new defenders in recent years. Such defenders typically either downplay the normative significance of autonomy or deny that we are sufficiently rational for paternalistic interventions to be objectionable.1 Both of these argumentative strategies constitute challenges to John Stuart Mill’s influential anti-paternalistic ‘harm principle’, which states that coercive interference with the liberty of competent adults is justifiable only if such interference prevents harm to non-consenting third parties (Mill, p. 23).2 In this journal, Wilkinson has provided a novel, provocative (...)
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  126.  49
    Reasoning and reversibility in capacity law.Binesh Hass - 2023 - Journal of Medical Ethics 49 (6):439-443.
    A key objective of the law in the assessment of decision-making capacity in clinical settings is to allow clinicians and judges to avoid making value judgements about the reasons that patients use to refuse treatment. This paper advances two lines of argument in respect of this objective. The first is that authorities cannot rationally avoid significant evaluative judgements in the assessment of a patient’s own assessment of the facts of their case. Assessing reasoning is unavoidably value-laden. Yet the underlying motivation (...)
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  127.  1
    Ethical analysis examining the prioritisation of living donor transplantation in times of healthcare rationing.Sanjay Kulkarni, Andrew Flescher, Mahwish Ahmad, George Bayliss, David Bearl, Lynsey Biondi, Earnest Davis, Roshan George, Elisa Gordon, Tania Lyons, Aaron Wightman & Keren Ladin - 2023 - Journal of Medical Ethics 49 (6):389-392.
    The transplant community has faced unprecedented challenges balancing risks of performing living donor transplants during the COVID-19 pandemic with harms of temporarily suspending these procedures. Decisions regarding postponement of living donation stem from its designation as an elective procedure, this despite that the Centers for Medicare and Medicaid Services categorise transplant procedures as tier 3b (high medical urgency—do not postpone). In times of severe resource constraints, health systems may be operating under crisis or contingency standards of care. In this manuscript, (...)
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  128.  4
    Making psychiatry moral again: the role of psychiatry in patient moral development.Doug McConnell, Matthew Broome & Julian Savulescu - 2023 - Journal of Medical Ethics 49 (6):423-427.
    Psychiatric involvement in patient morality is controversial. If psychiatrists are tasked with shaping patient morality, the coercive potential of psychiatry is increased, treatment may be unfairly administered on the basis of patients’ moral beliefs rather than medical need, moral disputes could damage the therapeutic relationship and, in any case, we are often uncertain or conflicted about what is morally right. Yet, there is also a strong case for the view that psychiatry often works through improving patient morality and, therefore, should (...)
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  129.  11
    Proposal to support making decisions about the organ donation process.Greg Moorlock & Heather Draper - 2023 - Journal of Medical Ethics 49 (6):434-438.
    In this paper, we propose a novel approach to permit members of the public opportunity to record more nuanced wishes in relation to organ donation. Recent developments in organ donation and procurement have made the associated processes potentially more multistaged and complex than ever. At the same time, opt-out legislation has led to a more simplistic recording of wishes than ever. We argue that in order to be confident that a patient would really wish to go ahead with the various (...)
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  130.  5
    Ethics briefing.Rebecca Mussell, Sophie Brannan, Veronica English, Caroline Ann Harrison & Julian C. Sheather - 2023 - Journal of Medical Ethics 49 (6):449-450.
    At the time of writing, the UK Government’s ‘Illegal Migration Bill’1 had started progressing through the House of Commons. The Bill will enable the removal of people who have come to the UK seeking asylum by ‘illegal’ routes, including via the dangerous Channel crossing in small boats.2 That duty would apply whether a person makes a protection claim, human rights claim or is a victim of modern slavery or human trafficking. Asylum seekers risk crossing the Channel because there are very (...)
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  131. Regulating abortion after ectogestation.Joona Räsänen - 2023 - Journal of Medical Ethics 49 (6):419-422.
    A few decades from now, it might become possible to gestate fetuses in artificial wombs. Ectogestation as this is called, raises major legal and ethical issues, especially for abortion rights. In countries allowing abortion, regulation often revolves around the viability threshold—the point in fetal development after which the fetus can survive outside the womb. How should viability be understood—and abortion thus regulated—after ectogestation? Should we ban, allow or require the use of artificial wombs as an alternative to standard abortions? Drawing (...)
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  132.  5
    Reimagining research ethics to include environmental sustainability: a principled approach, including a case study of data-driven health research.Gabrielle Samuel & Cristina Richie - 2023 - Journal of Medical Ethics 49 (6):428-433.
    In this paper we argue the need to reimagine research ethics frameworks to include notions of environmental sustainability. While there have long been calls for healthcareethics frameworks and decision-making to include aspects of sustainability, less attention has focused on howresearchethics frameworks could address this. To do this, we first describe the traditional approach to research ethics, which often relies on individualised notions of risk. We argue that we need to broaden this notion of individual risk to consider issues associated with (...)
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  133.  9
    Paternalism, with and without identity.Ben Saunders - 2023 - Journal of Medical Ethics 49 (6):409-410.
    Interference is paternalistic when it restricts an individual’s freedom for their own good. Anti-paternalists, such as John Stuart Mill, object to this for various reasons, including that the individual is usually a better judge of her own interests than the would-be paternalist. However, Wilkinson argues that a Parfitian reductivist approach to personal identity opens the door to what he calls ‘identity-relative paternalism’ where someone’s present action is restricted for the sake of a different future self.1 This is an interesting argument, (...)
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  134. Identity-relative paternalism is internally incoherent.Eli Garrett Schantz - 2023 - Journal of Medical Ethics 49 (6):404-405.
    Identity-Relative Paternalism, as defended by Wilkinson, holds that paternalistic intervention is justified to prevent an individual from doing to their future selves (where there are weakened prudential unity relations between the current and future self) what it would be justified to prevent them from doing to others.1 Wilkinson, drawing on the work of Parfit and others, defends the notion of Identity-Relative Paternalism from a series of objections. I argue here, however, that Wilkinson overlooks a significant problem for Identity-Relative Paternalism—namely, that (...)
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  135.  8
    On Wilkinson: unpacking Parfit, paternalism and the primacy of autonomy in contemporary bioethics.Linda Sheahan & Louise Campbell - 2023 - Journal of Medical Ethics 49 (6):415-416.
    In his essay on paternalism and personal identity, Wilkinson draws on Derek Parfit’s Reasons and Persons (1984) to call for a reappraisal of the role of paternalism in healthcare decision-making in situations in which patients with capacity make decisions which are likely to have harmful consequences for themselves.1 The imperative to respect autonomy, coupled with JS Mill’s insistence that the state is justified in interfering with an individual’s liberty only in situations in which she harms or threatens to harm another (...)
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  136.  15
    Ethical theories as multiple models.Isaac A. Wagner - 2023 - Journal of Medical Ethics 49 (6):444-446.
    Hardman and Hutchinson claim that ethics is ‘grounded in particular, everyday concerns’. According to them, an implication of this is that ethics courses for (future) clinicians should de-emphasise teaching the theories and principles of philosophical ethics and focus instead on pedagogical activities more closely related to everyday concerns, for example, exposure to real patient accounts. I respond that, even if ethics is an ‘everyday’ phenomenon, learning philosophical ethics may be of significant practical benefit to clinicians. I argue that the theories (...)
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  137.  4
    Implications of identity-relative paternalism.Dominic Wilkinson - 2023 - Journal of Medical Ethics 49 (6):417-418.
    I am grateful to the commentators for their thoughtful engagement with my paper.1 I am unable in this short response to reply to all of the important questions raised. Instead, I will focus on the practical application of identity-relative paternalism. Some commentators felt that this novel concept would yield implausible implications,2 others that it would have no impact because of uncertainty,3 or because existing ethical principles would yield the same conclusion.4 In the paper, I proposed the following principle: > Identity-relative (...)
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  138.  15
    The harm principle, personal identity and identity-relative paternalism.Dominic Wilkinson - 2023 - Journal of Medical Ethics 49 (6):393-402.
    Is it ethical for doctors or courts to prevent patients from making choices that will cause significant harm to themselves in the future? According to an important liberal principle the only justification for infringing the liberty of an individual is to prevent harm to others; harm to the self does not suffice.In this paper, I explore Derek Parfit’s arguments that blur the sharp line between harm to self and others. I analyse cases of treatment refusal by capacitous patients and describe (...)
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  139.  7
    Knowledge from the global South is in the global South.Seye Abimbola - 2023 - Journal of Medical Ethics 49 (5):337-338.
    In social systems or spaces, distance between the centre and the periphery breeds epistemic injustice. There are growing accounts of epistemic injustice in health-related fields, as in the article by Pratt and de Vries.1 The title of the article asks: ‘Where is knowledge from the global South?’ Like me, you may answer by saying: ‘Knowledge from the global South is in the global South’. That answer says a lot about how we right epistemic injustice done to actors in the global (...)
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  140.  9
    Epistemic justice and feminist bioethics in global health.Ilana Ambrogi, Luciana Brito & Roberta Lemos dos Santos - 2023 - Journal of Medical Ethics 49 (5):345-346.
    Doctors Pratt and de Vries propose a well-structured and courageous approach to analyse and repair an insufficiently recognised discussion about epistemologies and knowledge production in bioethics.1 The authors invite researchers, scholars, public health experts and bioethicists from the global North to reflect about their lack of imagination regarding different sources of narratives produced by the global South. There is a critical analysis of injustices and an urgent call for global bioethicists to reorient their field and focus on the analysis and (...)
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  141.  4
    Some barriers to knowledge from the global south: commentary to Pratt and de Vries.Caesar Alimsinya Atuire - 2023 - Journal of Medical Ethics 49 (5):335-336.
    Pratt and de Vries1 pose an important and uncomfortable question to all stakeholders in the global bioethics space. If global bioethics as they define it is ‘the ethics of public health and healthcare problems that are characterised by a global level effect or that require action beyond individual countries, and the ethics of research related to such problems’, one would expect justice and inclusivity to be among the ethical priorities. Yet, Pratt and de Vries carefully demonstrate how different forms of (...)
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  142.  11
    Heritable human genome editing is ‘currently not permitted’, but it is no longer ‘prohibited’: so says the ISSCR.Françoise Baylis - 2023 - Journal of Medical Ethics 49 (5):319-321.
    The Guidelines for Stem Cell Research and Clinical Translation, recently issued by the International Society for Stem Cell Research (ISSCR), include a number of substantive revisions. Significant changes include: (1) the bifurcation of ‘Category 3 Prohibited research activities’ in the 2016 Guidelines into ‘Category 3A Research activities currently not permitted’ and ‘Category 3B Prohibited research activities’ in the 2021 guidelines and (2) the move of heritable human genome editing research out of the ‘prohibited’ category and into the ‘currently not permitted’ (...)
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  143.  13
    Parent-initiated posthumous-assisted reproduction revisited in light of the interest in genetic origins.Ya'arit Bokek-Cohen & Vardit Ravitsky - 2023 - Journal of Medical Ethics 49 (5):357-360.
    A rich literature in bioethics argues against the use of anonymous gamete donation in the name of the ‘interest in knowing one’s genetic origins’. This interest stems from medical as well as psychosocial and identity reasons. The term ‘genealogical bewilderment’ has been coined to express the predicament of those deprived of access to information about their origins. Another rich body of literature in bioethics discusses arguments for and against posthumous-assisted reproduction (PAR), with a recent focus on PAR that is initiated (...)
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  144.  12
    Global health justice: epistemic theory and pandemic practice.Kenneth Boyd - 2023 - Journal of Medical Ethics 49 (5):303-304.
    What does justice in global health bioethics require, and how might we achieve it? Two important contributions to this issue of the Journal address theoretical and practical aspects of these questions in different but complementary ways. From their careful analysis of ‘epistemic injustice’ in global health ethics (‘injustice as it applies to knowledge’ which in one way or another puts a person at a disadvantage), Pratt and de Vries1 conclude that to achieve justice, much depends on what is meant by (...)
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  145.  12
    Repairing moral injury takes a team: what clinicians can learn from combat veterans.Jonathan M. Cahill, Warren Kinghorn & Lydia Dugdale - 2023 - Journal of Medical Ethics 49 (5):361-366.
    Moral injury results from the violation of deeply held moral commitments leading to emotional and existential distress. The phenomenon was initially described by psychologists and psychiatrists associated with the US Departments of Defense and Veterans Affairs but has since been applied more broadly. Although its application to healthcare preceded COVID-19, healthcare professionals have taken greater interest in moral injury since the pandemic’s advent. They have much to learn from combat veterans, who have substantial experience in identifying and addressing moral injury—particularly (...)
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  146.  3
    UK Research Ethics Committee’s review of the global first SARS-CoV-2 human infection challenge studies.Hugh Davies - 2023 - Journal of Medical Ethics 49 (5):322-324.
    This paper describes the UK Research Ethics Committee’s (REC) preparations and review of the global first SARS-CoV-2 human infection challenge studies. To frame our review, we used the WHO guidance and our UK Health Research Authority ethical review framework. The WHO criteria covered most issues we were concerned about, but we would recommend one further criterion directing RECs to consider alternative research designs. Could research questions be equally well answered by less intrusive studies? The committee met virtually, ensuring broad representation (...)
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  147.  17
    Epistemic justice in bioethics: interculturality and the possibility of reparations.Jantina de Vries & Bridget Pratt - 2023 - Journal of Medical Ethics 49 (5):347-347.
    The topic of epistemic injustice in global health ethics is complex, important and vast. While presenting as nuanced and complete a picture of the challenge as we possibly could, we were acutely aware of our positionality and how it gave us a certain viewpoint that would need to be expanded by others with different positions and experiences. We were, therefore, delighted to receive the collected commentaries by Atuire,1 Abimbola,2 Frimpong-Mansoh,3 Nyamnjoh and Ewuoso,4 Tangwa,5 Ambrogi et al.6 We would like to (...)
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  148.  3
    Intercultural global bioethics.Yaw Frimpong-Mansoh - 2023 - Journal of Medical Ethics 49 (5):339-340.
    Over the last two decades or so, the need to decolonise bioethics and make it inclusive, equitable and accommodative of voices from the traditionally marginalised global South has received increasing attention in academic scholarship. The recent publication by Pratt and de Vries offers a very comprehensive critical analysis and thoughtful overview of the issue, using global health ethics as its starting point.1 I fundamentally agree with their characterisation of the issue as an ‘epistemic justice’ problem. I further find their recommended (...)
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  149.  7
    Health disparities from pandemic policies: reply to critics.Nancy S. Jecker - 2023 - Journal of Medical Ethics 49 (5):348-349.
    In ‘Does zero-COVID neglect health disparities?’ we made the case that strict zero-COVID policies implemented during the coronavirus 2019 disease (COVID-19) pandemic raise health equity concerns so serious that these policies are not ethically sustainable.1 Zero-COVID, which has dominated many Pacific Rim societies, sets zero deaths from COVID-19 as a goal, and aims to reach it by forcefully containing transmission through short-term lockdowns, followed by stringent find, test, trace and isolate methods. Since the paper appeared in 2021, the Omicron variant (...)
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  150.  26
    Towards a new model of global health justice: the case of COVID-19 vaccines.Nancy S. Jecker, Caesar A. Atuire & Susan J. Bull - 2023 - Journal of Medical Ethics 49 (5):367-374.
    This paper questions an exclusively state-centred framing of global health justice and proposes a multilateral alternative. Using the distribution of COVID-19 vaccines to illustrate, we bring to light a broad range of global actors up and down the chain of vaccine development who contribute to global vaccine inequities. Section 1 (Background) presents an overview of moments in which diverse global actors, each with their own priorities and aims, shaped subsequent vaccine distribution. Section 2 (Collective action failures) characterises collective action failures (...)
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  151.  11
    Lessons learned from the Last Gift study: ethical and practical challenges faced while conducting HIV cure-related research at the end of life.John Kanazawa, Stephen A. Rawlings, Steven Hendrickx, Sara Gianella, Susanna Concha-Garcia, Jeff Taylor, Andy Kaytes, Hursch Patel, Samuel Ndukwe, Susan J. Little, Davey Smith & Karine Dubé - 2023 - Journal of Medical Ethics 49 (5):305-310.
    The Last Gift is an observational HIV cure-related research study conducted with people with HIV at the end of life (EOL) at the University of California San Diego. Participants agree to voluntarily donate blood and other biospecimens while living and their bodies for a rapid research autopsy postmortem to better understand HIV reservoir dynamics throughout the entire body. The Last Gift study was initiated in 2017. Since then, 30 volunteers were enrolled who are either (1) terminally ill with a concomitant (...)
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  152.  3
    How useful is the category of ‘assisted gestative technologies’?Julian Koplin - 2023 - Journal of Medical Ethics 49 (5):350-351.
    Elizabeth Chloe Romanis argues that surrogacy, uterine transplantation (UTx) and ectogestation belong to a genus of ‘assisted gestative technologies” (“AGTs”).1 These technologies are conceptually distinct from assisted reproductive technologies (ARTs) in that they support gestation rather than conception. Romanis argues that they also raise some overlapping ethical and policy issues that are best appreciated by ‘considering these technologies together’, thus placing the issues that AGT’s share at the forefront of ethical analysis. The neologism ‘AGTs’ picks out a distinctive and important (...)
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  153.  9
    Beyond regulatory approaches to ethics: making space for ethical preparedness in healthcare research.Kate Lyle, Susie Weller, Gabby Samuel & Anneke M. Lucassen - 2023 - Journal of Medical Ethics 49 (5):352-356.
    Centralised, compliance-focused approaches to research ethics have been normalised in practice. In this paper, we argue that the dominance of such systems has been driven by neoliberal approaches to governance, where the focus on controlling and individualising risk has led to an overemphasis of decontextualised ethical principles and the conflation of ethical requirements with the documentation of ‘informed consent’. Using a UK-based case study, involving a point-of-care-genetic test as an illustration, we argue that rather than ensuring ethical practice such compliance-focused (...)
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  154.  3
    Ethics of non-therapeutic research on imminently dying patients in the intensive care unit.Nicholas Murphy, Charles Weijer, Derek Debicki, Geoffrey Laforge, Loretta Norton, Teneille Gofton & Marat Slessarev - 2023 - Journal of Medical Ethics 49 (5):311-318.
    Non-therapeutic research with imminently dying patients in intensive care presents complex ethical issues. The vulnerabilities of the imminently dying, together with societal disquiet around death and dying, contribute to an intuition that such research is beyond the legitimate scope of scientific inquiry. Yet excluding imminently dying patients from research hinders the advancement of medical science to the detriment of future patients. Building on existing ethical guidelines for research, we propose a framework for the ethical design and conduct of research involving (...)
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  155.  5
    What type of inclusion does epistemic injustice require?Anye-Nkwenti Nyamnjoh & Cornelius Ewuoso - 2023 - Journal of Medical Ethics 49 (5):341-342.
    Bridget Pratt and Jantina de Vries1 have made an insightful contribution to enhancing epistemic justice in global health ethics. Their elaboration details intellectual (external) exclusion—described as non-representation—across three levels, and at its core, proposes inclusion to rectify this. To extend this work, we contend that it is worth probing the nuances and challenges associated with inclusion as a response to epistemic injustice. These include (A) the meaning of inclusion outside binary vocabularies of north and south; (B) the possibility of forms (...)
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  156.  6
    Where is knowledge from the global South? An account of epistemic justice for a global bioethics.Bridget Pratt & Jantina de Vries - 2023 - Journal of Medical Ethics 49 (5):325-334.
    The silencing of the epistemologies, theories, principles, values, concepts and experiences of the global South constitutes a particularly egregious epistemic injustice in bioethics. Our shared responsibility to rectify that injustice should be at the top of the ethics agenda. That it is not, or only is in part, is deeply problematic and endangers the credibility of the entire field. As a first step towards reorienting the field, this paper offers a comprehensive account of epistemic justice for global health ethics. We (...)
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  157.  5
    Root causes of epistemic (in)justice for the global south in health ethics and bioethics.Godfrey B. Tangwa - 2023 - Journal of Medical Ethics 49 (5):343-344.
    In a feature article in the Journal of Medical Ethics entitled ‘Where is knowledge from the global South? An account of epistemic justice for a global bioethics’,1 Pratt and de Vries give a highly persuasive account of global injustices within global bioethics especially health ethics against the global South that every bioethicist needs to read and to reflect on. The opening three sentences of the abstract of this account capture the ethical essence of the whole article. > The silencing of (...)
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  158.  11
    Call to action: empowering patients and families to initiate clinical ethics consultations.Liz Blackler, Amy E. Scharf, Konstantina Matsoukas, Michelle Colletti & Louis P. Voigt - 2023 - Journal of Medical Ethics 49 (4):240-243.
    Clinical ethics consultations exist to support patients, families and clinicians who are facing ethical or moral challenges related to patient care. They provide a forum for open communication, where all stakeholders are encouraged to express their concerns and articulate their viewpoints. Ethics consultations can be requested by patients, caregivers or members of a patient’s clinical or supportive team. Althoughpatientsand by extension their families (especially in cases of decisional incapacity) are the common denominators in most ethics consultations, these constituents are theleastlikely (...)
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  159.  7
    Different approach to medical decision-making in difficult circumstances: Kittay’s Ethics of Care.Liam Butchart, Kristin Krumenacker & Aymen Baig - 2023 - Journal of Medical Ethics 49 (4):293-299.
    The onset of the COVID-19 pandemic has necessitated advances in bioethical approaches to medical decision-making. This paper develops an alternative method for rationing care during periods of resource scarcity. Typical approaches to triaging rely on utilitarian calculations; however, this approach introduces a problematic antihumanist sentiment, inviting the proposition of alternative schemata. As such, we suggest a feminist approach to medical decision-making, founded in and expanding upon the framework of Eva Kittay’s Ethics of Care. We suggest that this new structure addresses (...)
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  160.  5
    Suffering, existential distress and temporality in the provision of terminal sedation.Nathan Emmerich & Michael Chapman - 2023 - Journal of Medical Ethics 49 (4):263-264.
    While there is a great deal to agree with in the essay Expanded Terminal Sedation in End-of-Life Care there is, we think, a need to more fully appreciate the humanistic side of both palliative and end-of-life care.1 Not only does the underlying philosophy of palliative care arguably differ from that which guides curative medicine,2 dying patients are in a uniquely vulnerable position given our cultural disinclination towards open discussions of death and dying. In this brief response, we critically engage Gilbertson (...)
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  161.  11
    Imagination and idealism in the medical sciences of an ageing world.Colin Farrelly - 2023 - Journal of Medical Ethics 49 (4):271-274.
    Imagination and idealism are particularly important creative epistemic virtues for the medical sciences if we hope to improve the health of the world’s ageing population. To date, imagination and idealism within the medical sciences have been dominated by a paradigm of disease control, a paradigm which has realised significant, but also limited, success. Disease control proved particularly successful in mitigating the early-life mortality risks from infectious diseases, but it has proved less successful when applied to the chronic diseases of late (...)
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  162.  10
    Expanded terminal sedation in end-of-life care.Laura Gilbertson, Julian Savulescu, Justin Oakley & Dominic Wilkinson - 2023 - Journal of Medical Ethics 49 (4):252-260.
    Despite advances in palliative care, some patients still suffer significantly at the end of life. Terminal Sedation (TS) refers to the use of sedatives in dying patients until the point of death. The following limits are commonly applied: (1) symptoms should be refractory, (2) sedatives should be administered proportionally to symptoms and (3) the patient should be imminently dying. The term ‘Expanded TS’ (ETS) can be used to describe the use of sedation at the end of life outside one or (...)
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  163.  19
    Epistemic injustice, children and mental illness: reply to comments.Edward Harcourt - 2023 - Journal of Medical Ethics 49 (4):292-292.
    I’m grateful to the commentators for their thoughtful and thought-provoking replies. Psychiatric service-users often feel disempowered relative to a profession (psychiatry) and so sometimes enlist the aid of another profession (philosophy) to redress the balance. All well and good, but it is vital in this context not to set one’s critical faculties on one side. Although Dr Kious1 thinks that is just what I have done, what I was trying to do was to call a halt to the uncritical use (...)
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  164.  4
    Surgery should be routinely videoed.Edwin Jesudason - 2023 - Journal of Medical Ethics 49 (4):235-239.
    Video recording is widely available in modern operating rooms. Here, I argue that, if patient consent and suitable technology are in place, video recording of surgery is an ethical duty. I develop this as aduty to protect,arguing for professional and institutional duties, as distinguished forduties of rescue.A professional duty to protect is described in mental healthcare. Practitioners have to take reasonable steps to prevent serious, foreseeable harm to their clients and others, even if that entails a non-consensual breach of confidentiality. (...)
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  165.  3
    Translating Cultural Safety to the UK.Amali U. Lokugamage, Elizabeth Rix, Tania Fleming, Tanvi Khetan, Alice Meredith & Carolyn Ruth Hastie - 2023 - Journal of Medical Ethics 49 (4):244-251.
    Disproportional morbidity and mortality experienced by ethnic minorities in the UK have been highlighted by the COVID-19 pandemic. The ‘Black Lives Matter’ movement has exposed structural racism’s contribution to these health inequities. ‘Cultural Safety’, an antiracist, decolonising and educational innovation originating in New Zealand, has been adopted in Australia. Cultural Safety aims to dismantle barriers faced by colonised Indigenous peoples in mainstream healthcare by addressing systemic racism.This paper explores what it means to be ‘culturally safe’. The ways in which New (...)
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  166.  4
    Humility.John McMillan - 2023 - Journal of Medical Ethics 49 (4):227-228.
    Hume criticised ‘humility’ as a ‘monkish virtue’ and objected to it on the basis that such virtues ‘stupefy the understanding and harden the heart, obscure the fancy and sour the temper.’1 Despite the appeal of Hume’s plea for less restraint and self-denial, other thinkers such as Kant consider epistemic humility to be fundamental, given the limits of our rationality and our struggle to know and do the right thing.2 By epistemic humility, he did not mean weakness or being self-effacing, instead (...)
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  167.  15
    Against visitor bans: freedom of association, COVID-19 and the hospital ward.Emily McTernan - 2023 - Journal of Medical Ethics 49 (4):288-291.
    To ban or significantly restrict visitors for patients in hospital could seem to be simply a sensible and easy precaution to take during a pandemic: a policy that is unpopular, perhaps, and even unfortunate, but not something that wrongs anyone. However, I argue that in fact such restrictions on visitors infringe upon a fundamental right, to freedom of association. While there may still be permissible restrictions on visitors, making the case for these becomes highly demanding. One common way to understand (...)
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  168.  6
    Ethical uncertainty and COVID-19: exploring the lived experiences of senior physicians at a major medical centre.Ruaim Muaygil, Raniah Aldekhyyel, Lemmese AlWatban, Lyan Almana, Rana F. Almana & Mazin Barry - 2023 - Journal of Medical Ethics 49 (4):275-282.
    Given the wide-reaching and detrimental impact of COVID-19, its strain on healthcare resources, and the urgent need for—sometimes forced—public health interventions, thorough examination of the ethical issues brought to light by the pandemic is especially warranted. This paper aims to identify some of the complex moral dilemmas faced by senior physicians at a major medical centre in Saudi Arabia, in an effort to gain a better understanding of how they navigated ethical uncertainty during a time of crisis. This qualitative study (...)
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  169.  6
    Ethics briefing.Rebecca Mussell, Sophie Brannan, Veronica English, Caroline Ann Harrison & Julian C. Sheather - 2023 - Journal of Medical Ethics 49 (4):301-302.
    In December 2022, the Office of the National Data Guardian (NDG)1 for health and social care in England published new guidance: What do we mean by public benefit? Evaluating public benefit when health and adult social care data is used for purposes beyond individual care.2 Research in the UK consistently demonstrates that for the public to consider a secondary use3 of health and care data appropriate and acceptable, it must deliver a benefit back to the public.4 The aim of the (...)
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  170.  5
    Pandemic justice: fairness, social inequality and COVID-19 healthcare priority-setting.Lasse Nielsen & Andreas Albertsen - 2023 - Journal of Medical Ethics 49 (4):283-287.
    A comprehensive understanding of the ethics of the COVID-19 pandemic priorities must be sensitive to the influence of social inequality. We distinguish between ex-ante and ex-post relevance of social inequality for COVID-19 disadvantage. Ex-ante relevance refers to the distribution of risks of exposure. Ex-post relevance refers to the effect of inequality on how patients respond to infection. In the case of COVID-19, both ex-ante and ex-post effects suggest a distribution which is sensitive to the prevalence social inequality. On this basis, (...)
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  171.  5
    Expanded terminal sedation: dangerous waters.Thomas David Riisfeldt - 2023 - Journal of Medical Ethics 49 (4):261-262.
    Gilbertson et al should be commended for their insightful exploration of expanded terminal sedation (ETS)1; however, there are a number of concerns that I will address in this response. I will first better characterise the currently accepted and commonplace ‘standard’ TS (STS), and then argue that the advocated forms of ETS draw very close to—and at times clearly constitute a subtype of—euthanasia, as opposed to representing a similar but separate practice. I will then conclude with concerns regarding the inappropriate application (...)
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  172.  9
    Expanded terminal sedation: too removed from real-world practice.Guy Schofield & Idris Baker - 2023 - Journal of Medical Ethics 49 (4):267-268.
    Gilbertson et al present a considered analysis of the abstract problem of ‘sedation’ at the end of life,1 and it is reassuring to see the separation of multiple practises that are often grouped under the heading terminal sedation. In their work, the authors attempt to introduce and justify a new practice in the care of those dying with significant suffering—expanded terminal sedation (ETS). This analysis will not, however, help our colleagues at the bedside. Here, we will focus on the flaws (...)
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  173.  7
    Implications of extended terminal sedation.Paul Clay Sorum & David S. Pratt - 2023 - Journal of Medical Ethics 49 (4):265-266.
    Gilbertson, Savulescu, Oakley and Wilkinson propose extending the availability of terminal sedation (TS) to patients with intractable pain and/or suffering who are expected to live more than 2 weeks (hence the designation of extended TS (ETS)) and to patients whose values are known but who do not have decision-making capacity.1 Their plan is worthy of serious consideration: it is, after all, based on the fundamental and well-recognised medical ethical values of patient autonomy and beneficence. But, even when restricted to jurisdictions (...)
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  174.  6
    Clinical law: what do clinicians want to know? The demography of clinical law.Robert Wheeler & Nigel Hall - 2023 - Journal of Medical Ethics 49 (4):229-234.
    This is the first description of the questions that clinicians ask a department of clinical law, relating to the legal rules applicable to the care of their patients.ObjectivesTo describe in detail the demography of clinical legal enquiries made by clinicians of all professions concerning the care of their patients. To collate and categorise the varieties of enquiry, to identify phenotypic patterns. To provide colleges, regulators, commissioners, educators and the NHS with an insight into hitherto undescribed subject matter, better to understand (...)
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  175.  8
    Expanding choice at the end of life.Dominic Wilkinson, Laura Gilbertson, Justin Oakley & Julian Savulescu - 2023 - Journal of Medical Ethics 49 (4):269-270.
    We are grateful to the commentators on our article1 for their thoughtful engagement with the ethical and clinical complexity of expanded terminal sedation (ETS) in end-of-life care. We will start by noting some points of common ground, before moving on to the more challenging ways in which TS might be permissibly expanded. First, several commentators pointed out, and we completely concur, that it is important to provide patients with full information about their end-of-life options, including the ‘outcomes, uncertainties and costs (...)
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  176.  12
    Endosex.Morgan Carpenter, Katharine B. Dalke & Brian D. Earp - 2023 - Journal of Medical Ethics 49 (3):225-226.
    Endosex, in contrast to intersex, refers to innate physical sex characteristics judged to fall within the broad range of what is considered normative or typical for ‘binary’ female or male bodies by the medical field, or to persons with such characteristics1 (p. 437). In this short contribution, we explain the origins and increasing use of this little-known term and discuss its practical and ethical relevance to medicine as well as to scholarship from a range of disciplines concerned with individuals’ sexed (...)
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  177.  12
    Conscientious objection and the referral requirement as morally permissible moral mistakes.Nathan Emmerich - 2023 - Journal of Medical Ethics 49 (3):189-195.
    Some contributions to the current literature on conscience objection in healthcare posit the notion that the requirement to refer patients to a non-objecting provider is a morally questionable undertaking in need of explanation. The issue is that providing a referral renders those who conscientiously object to being involved in a particular intervention complicit in its provision. This essay seeks to engage with such claims and argues that referrals can be construed in terms of what Harman calls morally permissible moral mistakes. (...)
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  178.  15
    AI knows best? Avoiding the traps of paternalism and other pitfalls of AI-based patient preference prediction.Andrea Ferrario, Sophie Gloeckler & Nikola Biller-Andorno - 2023 - Journal of Medical Ethics 49 (3):185-186.
    In our recent article ‘The Ethics of the Algorithmic Prediction of Goal of Care Preferences: From Theory to Practice’1, we aimed to ignite a critical discussion on why and how to design artificial intelligence (AI) systems assisting clinicians and next-of-kin by predicting goal of care preferences for incapacitated patients. Here, we would like to thank the commentators for their valuable responses to our work. We identified three core themes in their commentaries: (1) the risks of AI paternalism, (2) worries about (...)
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  179.  11
    Ethics of the algorithmic prediction of goal of care preferences: from theory to practice.Andrea Ferrario, Sophie Gloeckler & Nikola Biller-Andorno - 2023 - Journal of Medical Ethics 49 (3):165-174.
    Artificial intelligence (AI) systems are quickly gaining ground in healthcare and clinical decision-making. However, it is still unclear in what way AI can or should support decision-making that is based on incapacitated patients’ values and goals of care, which often requires input from clinicians and loved ones. Although the use of algorithms to predict patients’ most likely preferred treatment has been discussed in the medical ethics literature, no example has been realised in clinical practice. This is due, arguably, to the (...)
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  180.  6
    Broadening the debate: the future of JME feature articles.Lucy Frith & John McMillan - 2023 - Journal of Medical Ethics 49 (3):155-155.
    The JME editorial team selects its feature articles from the best papers accepted for publication based on their quality, novelty and capacity to move debate forward on a specific issue. Feature articles are made freely available and are published alongside reviewed and submitted commentaries. We do this partly to promote and acknowledge excellent work in medical ethics, but also to encourage authors to submit their best papers to the JME. JME feature articles have deepened the analysis of some central issues (...)
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  181.  8
    Patient portal access for caregivers of adult and geriatric patients: reframing the ethics of digital patient communication.Teja Ganta, Jacob M. Appel & Nicholas Genes - 2023 - Journal of Medical Ethics 49 (3):156-159.
    Patient portals are poised to transform health communication by empowering patients with rapid access to their own health data. The 21st Century Cures Act is a US federal law that, among other provisions, prevents health entities from engaging in practices that disrupt the exchange of electronic health information—a measure that may increase the usage of patient health portals. Caregiver access to patient portals, however, may lead to breaches in patient privacy and confidentiality if not managed properly through proxy accounts. We (...)
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  182.  9
    ‘VaxTax’: a follow-up proposal for a global vaccine pandemic response fund.Federico Germani, Felicitas Holzer, Ivette Ortiz, Nikola Biller-Andorno & Julian W. März - 2023 - Journal of Medical Ethics 49 (3):160-164.
    Equal access to vaccines has been one of the key ethical challenges during the COVID-19 pandemic. Most scholars consider the massive purchase and hoarding of vaccines by high-income countries, especially at the beginning of the pandemic, to be unjust towards the vulnerable living in low-income countries. A recent proposal by Andreas Albertsen of a vaccine tax has been put forward to remedy this problem. Under such a scheme, high-income countries would pay a contribution, conceptualised as a vaccine tax, dedicated to (...)
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  183.  19
    Vaccine mandates for healthcare workers beyond COVID-19.Alberto Giubilini, Julian Savulescu, Jonathan Pugh & Dominic Wilkinson - 2023 - Journal of Medical Ethics 49 (3):211-220.
    We provide ethical criteria to establish when vaccine mandates for healthcare workers are ethically justifiable. The relevant criteria are the utility of the vaccine for healthcare workers, the utility for patients (both in terms of prevention of transmission of infection and reduction in staff shortage), and the existence of less restrictive alternatives that can achieve comparable benefits. Healthcare workers have professional obligations to promote the interests of patients that entail exposure to greater risks or infringement of autonomy than ordinary members (...)
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  184.  4
    Fracking our humanity.Edwin Jesudason - 2023 - Journal of Medical Ethics 49 (3):181-182.
    Nietzche claimed that once we know why to live, we’ll suffer almost any how.1 Artificial intelligence (AI) is used widely for the how, but Ferrario et al now advocate using AI for the why.2 Here, I offer my doubts on practical grounds but foremost on ethical ones. Practically, individuals already vacillate over the why, wavering with time and circumstance. That AI could provide prosthetics (or orthotics) for human agency feels unrealistic here, not least because ‘answers’ would be largely unverifiable. Ethically, (...)
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  185.  7
    Verification and trust in healthcare.Edwin Jesudason - 2023 - Journal of Medical Ethics 49 (3):223-224.
    ‘Trust but verify’ is a translation of a Russian proverb made famous by former US President Ronald Reagan. In their paper, Grahamet alappear to take an alternate view that might be summarised astrust or verify. The contrast highlights a general question: how do we come to trust in authorities? More specifically, Grahamet alclaim: (1) that UK Trusted Research Environments (TREs) are misnamed as future custodians for big health data because their promised verification systems actually negate the uncertainty that trust requires; (...)
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  186. Surrogacy: beyond the commercial/altruistic distinction.Ji-Young Lee - 2023 - Journal of Medical Ethics 49 (3).
    In this article, I critique the commonly accepted distinction between commercial and altruistic surrogacy arrangements. The moral legitimacy of surrogacy, I claim, does not hinge on whether it is paid (‘commercial’) or unpaid (‘altruistic’); rather, it is best determined by appraisal of virtue-abiding conditions constitutive of the surrogacy arrangement. I begin my article by problematising the prevailing commercial/altruistic distinction; next, I demonstrate that an assessment of the virtue-abiding or non-virtue-abiding features of a surrogacy is crucial to navigating questions about the (...)
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  187. The Patient preference predictor and the objection from higher-order preferences.Jakob Thrane Mainz - 2023 - Journal of Medical Ethics 49 (3):221-222.
    Recently, Jardas _et al_ have convincingly defended the patient preference predictor (PPP) against a range of autonomy-based objections. In this response, I propose a new autonomy-based objection to the PPP that is not explicitly discussed by Jardas _et al_. I call it the ‘objection from higher-order preferences’. Even if this objection is not sufficient reason to reject the PPP, the objection constitutes a pro tanto reason that is at least as powerful as the ones discussed by Jardas _et al._.
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  188.  14
    Artificial intelligence paternalism.Ricardo Diaz Milian & Anirban Bhattacharyya - 2023 - Journal of Medical Ethics 49 (3):183-184.
    In response to Ferrario _et al_’s 1 work entitled ‘Ethics of the algorithmic prediction of goal of care preferences: from theory to practice’, we would like to point out an area of concern: the risk of artificial intelligence (AI) paternalism in their proposed framework. Accordingly, in this commentary, we underscore the importance of the implementation of safeguards for AI algorithms before they are deployed in clinical practice. The goal of documenting a living will and advanced directives is to convey personal (...)
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  189.  9
    The scope of patient, healthcare professional and healthcare systems responsibilities to reduce the carbon footprint of inhalers: a response to commentaries.Joshua Parker - 2023 - Journal of Medical Ethics 49 (3):187-188.
    I am grateful for these four wide-ranging and incisive commentaries on my paper discussing the ethical issues that arise when we consider the carbon footprint of inhalers.1 As I am unable to address every point raised, instead I focus on what I take to be the common thread running through these papers. Each response has something to say regarding the scope of healthcare’s responsibility to mitigate climate change. This can be explored at the intuitional or structural level, or at the (...)
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  190.  7
    ‘Climate change mitigation is a hot topic, but not when it comes to hospitals’: a qualitative study on hospital stakeholders’ perception and sense of responsibility for greenhouse gas emissions.Claudia Quitmann, Rainer Sauerborn, Ina Danquah & Alina Herrmann - 2023 - Journal of Medical Ethics 49 (3):204-210.
    ObjectivePhysical and mental well-being are threatened by climate change. Since hospitals in high-income countries contribute significantly to climate change through their greenhouse gas (GHG) emissions, the medical ethics imperative of ‘do no harm’ imposes a responsibility on hospitals to decarbonise. We investigated hospital stakeholders’ perceptions of hospitals’ GHG emissions sources and the sense of responsibility for reducing GHG emissions in a hospital.MethodsWe conducted 29 semistructured qualitative expert interviews at one of Germany’s largest hospitals, Heidelberg University Hospital. Five patients, 12 clinical (...)
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  191.  13
    What you believe you want, may not be what the algorithm knows.Seppe Segers - 2023 - Journal of Medical Ethics 49 (3):177-178.
    Tensions between respect for autonomy and paternalism loom large in Ferrario et al ’s discussion of artificial intelligence (AI)-based preference predictors.1 To be sure, their analysis (rightfully) brings out the moral matter of respecting patient preferences. My point here, however, is that their consideration of AI-based preference predictors in treatment of incapacitated patients opens more fundamental moral questions about the desirability of over-ruling considered patient preferences, not only if these are disclosed by surrogates, but possibly also in treating competent patients. (...)
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  192.  11
    For the sake of multifacetedness. Why artificial intelligence patient preference prediction systems shouldn’t be for next of kin.Max Tretter & David Samhammer - 2023 - Journal of Medical Ethics 49 (3):175-176.
    In their contribution ‘Ethics of the algorithmic prediction of goal of care preferences’1 Ferrario et al elaborate a from theory to practice contribution concerning the realisation of artificial intelligence (AI)-based patient preference prediction (PPP) systems. Such systems are intended to help find the treatment that the patient would have chosen in clinical situations—especially in the intensive care or emergency units—where the patient is no longer capable of making that decision herself. The authors identify several challenges that complicate their effective development, (...)
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  193.  13
    Diversity in clinical research: public health and social justice imperatives.Tanvee Varma, Camara P. Jones, Carol Oladele & Jennifer Miller - 2023 - Journal of Medical Ethics 49 (3):200-203.
    It is well established that demographic representation in clinical research is important for understanding the safety and effectiveness of novel therapeutics and vaccines in diverse patient populations. In recent years, the National Institutes of Health and Food and Drug Administration have issued guidelines and recommendations for the inclusion of women, older adults, and racial and ethnic minorities in research. However, these guidelines fail to provide an adequate explanation of why racial and ethnic representation in clinical research is important. This article (...)
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  194.  8
    Artificial Intelligence algorithms cannot recommend a best interests decision but could help by improving prognostication.Derick Wade - 2023 - Journal of Medical Ethics 49 (3):179-180.
    Most jurisdictions require a patient to consent to any medical intervention. Clinicians ask a patient, ‘Given the pain and distress associated with our intervention and the predicted likelihood of this best-case outcome, do you want to accept the treatment?’ When a patient is incapable of deciding, clinicians may ask people who know the patient to say what the patient would decide; this is substituted judgement. In contrast, asking the same people to say how the person would make the decision is (...)
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  195.  46
    Youth should decide: the principle of subsidiarity in paediatric transgender healthcare.Florence Ashley - 2023 - Journal of Medical Ethics 49 (2):110-114.
    Drawing on the principle of subsidiarity, this article develops a framework for allocating medical decision-making authority in the absence of capacity to consent and argues that decisional authority in paediatric transgender healthcare should generally lie in the patient. Regardless of patients’ capacity, there is usually nobody better positioned to make medical decisions that go to the heart of a patient’s identity than the patients themselves. Under the principle of subsidiarity, decisional authority should only be held by a higher level decision-maker, (...)
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  196.  8
    Dual duties to patient and planet: time to revisit the ethical foundations of healthcare?Anand Bhopal & Kristine Bærøe - 2023 - Journal of Medical Ethics 49 (2):102-103.
    When weighing up which inhaler to prescribe, a doctor may prioritise a patient’s preferences over the expected harms from the associated carbon emissions. Parker argues that this is wrong.1 Doctors have a pro-tanto duty to switch from a high-carbon metered-dose inhaler (MDI) to a low-carbon dry-powdered inhaler (DPI)—even though this provides no direct patient benefit—unless switching would undermine trust or significantly worsen a patient’s health. He goes on to state that even if DPIs are more expensive for the National Health (...)
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  197.  8
    Green inhaler prescribing and the ethical obligations of physicians.John Coverdale - 2023 - Journal of Medical Ethics 49 (2):99-99.
    In an accompanying feature article, Parker argued that general practitioners should support efforts by the National Health Service to reduce greenhouse gases by avoiding metered-dose inhalers and by prescribing similarly effective inhalers with smaller carbon footprints.1 He also argued that patients are not morally justified in declining to use dry powder inhalers which do not contain greenhouse gases and when judged to be readily available and similarly effective, unless, when patients resist that option, their trust in the professional relationship is (...)
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  198. Why the wrongness of intentionally impairing children in utero does not imply the wrongness of abortion.Simon Cushing - 2023 - Journal of Medical Ethics 49 (2):146-147.
    Perry Hendricks’ ‘impairment argument’, which he has defended in this journal, is intended to demonstrate that the generally conceded wrongness of giving a fetus fetal alcohol syndrome (FAS) shows that abortion must also be immoral, even if we allow that the fetus is not a rights-bearing moral person. The argument fails because the harm of causing FAS is extrinsic but Hendricks needs it to be intrinsic for it to show anything about abortion. Either the subject of the wrong of causing (...)
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  199.  6
    Do doctors have a responsibility to help patients import medicines from abroad?Narcyz Ghinea - 2023 - Journal of Medical Ethics 49 (2):131-135.
    Almost any medicine can be purchased online from abroad. Many high-income countries permit individuals to import medicines for their personal use. However, those who import medicines face the risk of purchasing poor-quality products that may not work, or that may even harm them. Many people are willing to accept this risk for the opportunity to purchase more affordable medicines. This is especially true of individuals from low socioeconomic backgrounds who already struggle to afford the medicines they need if they are (...)
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  200.  9
    ‘Green’ bioethics widens the scope of eligible values and overrides patient demand: comment on Parker.Anders Herlitz, Erik Malmqvist & Christian Munthe - 2023 - Journal of Medical Ethics 49 (2):100-101.
    Parker’s article is a welcome attempt to address the importance of environmental sustainability in the realm of clinical ethics.1 We support the recent movement to seriously consider the environmental impact of healthcare institutions in bioethics.2 3 Still, we find two partly linked weaknesses of Parker’s analysis and guideline suggestion. These relate to a need in ‘green’ bioethics to see beyond the normal healthcare ethical focus on health-related values related to individual patients, and to primarily adopt institutional ways of framing central (...)
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  201.  8
    Commitment devices: beyond the medical ethics of nudges.Nathan Hodson - 2023 - Journal of Medical Ethics 49 (2):125-130.
    Commitment devices (CDs) can help people overcome self-control problems to act on their plans and preferences. In these arrangements, people willingly make one of their options worse in order to change their own future behaviour, often by setting aside a sum of money that they will forfeit it if they fail to complete the planned action. Such applications of behavioural science have been used to help people stick to healthier lifestyle choices, overcome addictions and adhere to medication; they are acceptable (...)
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  202.  11
    Navigating our way through a hospital ransomware attack: ethical considerations in delivering acute orthopaedic care.Thomas William Hoffman & Joseph Frederick Baker - 2023 - Journal of Medical Ethics 49 (2):121-124.
    Ransomware attacks on healthcare systems are becoming more prevalent globally. In May 2021, Waikato District Health Board in New Zealand was devastated by a major attack that crippled its information technology system. The Department of Orthopaedic Surgery faced a number of challenges to the way they delivered care including, patient assessment and investigations, the deferral of elective surgery, and communication and patient confidentiality. These issues are explored through the lens of the four key principles of medical ethics in the hope (...)
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  203.  11
    Evaluating interventions to improve ethical decision making in clinical practice: a review of the literature and reflections on the challenges posed. [REVIEW]Agnieszka Ignatowicz, Anne Marie Slowther, Christopher Bassford, Frances Griffiths, Samantha Johnson & Karen Rees - 2023 - Journal of Medical Ethics 49 (2):136-142.
    Since the 1980s, there has been an increasing acknowledgement of the importance of recognising the ethical dimension of clinical decision-making. Medical professional regulatory authorities in some countries now include ethical knowledge and practice in their required competencies for undergraduate and post graduate medical training. Educational interventions and clinical ethics support services have been developed to support and improve ethical decision making in clinical practice, but research evaluating the effectiveness of these interventions has been limited. We undertook a systematic review of (...)
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  204.  13
    Critical role of pathology and laboratory medicine in the conversation surrounding access to healthcare.Cullen M. Lilley & Kamran M. Mirza - 2023 - Journal of Medical Ethics 49 (2):148-152.
    Pathology and laboratory medicine are a key component of a patient’s healthcare. From academic care centres, community hospitals, to clinics across the country, pathology data are a crucial component of patient care. But for much of the modern era, pathology and laboratory medicine have been absent from health policy conversations. Though select members in the field have advocated for an enhanced presence of these specialists in policy conversations, little work has been done to thoroughly evaluate the moral and ethical obligations (...)
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  205.  7
    Research in the USA on COVID-19’s long-term effects: measures needed to ensure black, indigenous and Latinx communities are not left behind.Michelle Medeiros, Hillary Anne Edwards & Claudia Rose Baquet - 2023 - Journal of Medical Ethics 49 (2):87-91.
    The SARS-CoV-2 (COVID-19) pandemic continues to expose underlying inequities in healthcare for black, indigenous and Latinx communities in the USA. The gaps in equitable care for communities of colour transcend the diagnosis, treatment and vaccinations related to COVID-19. We are experiencing a continued gap across racial and socioeconomic lines for those who suffer prolonged effects of COVID-19, also known as ‘Long COVID-19’. What we know about the treatment for Long COVID-19 so far is that it is complex, requires a multidisciplinary (...)
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  206.  7
    Reconsenting paediatric research participants for use of identifying data.Blake Murdoch, Allison Jandura & Timothy Caulfield - 2023 - Journal of Medical Ethics 49 (2):106-109.
    When a minor research participant reaches the age of majority or the level of maturity necessary to be granted legal decision-making capacity, reconsent can be required for ongoing participation in research or use of health information and banked biological materials. Despite potential logistical concerns with implementation and ethical questions about the trade-offs between maximising respect for participant agency and facilitating research that may generate benefits, reconsent is the approach most consistent with both law and research ethics.Canadian common law consent requirements (...)
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  207.  9
    Ethics briefing.Rebecca Mussell, Sophie Brannan, Veronica English, Caroline Ann Harrison & Julian C. Sheather - 2023 - Journal of Medical Ethics 49 (2):153-154.
    Health, ethics and COP27 On the 20 November 2022, the United Nations Climate Change COP27 announced a breakthrough agreement to provide ‘loss and damage’ funding for resource-poor countries seriously affected by climate change. 1 The establishment of the funding stream acknowledges, and attempts to address, one of many thorny ethical issues driven by climate change – to what extent countries that have benefited economically from past emissions of greenhouse gases owe reparative obligations to countries who have contributed minimally to climate (...)
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  208.  6
    Barriers to green inhaler prescribing: ethical issues in environmentally sustainable clinical practice.Joshua Parker - 2023 - Journal of Medical Ethics 49 (2):92-98.
    The National Health Service (NHS) was the first healthcare system globally to declare ambitions to become net carbon zero. To achieve this, a shift away from metered-dose inhalers which contain powerful greenhouse gases is necessary. Many patients can use dry powder inhalers which do not contain greenhouse gases and are equally effective at managing respiratory disease. This paper discusses the ethical issues that arise as the NHS attempts to mitigate climate change. Two ethical issues that pose a barrier to moving (...)
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  209.  6
    Strategic and principled approach to the ethical challenges of epilepsy monitoring unit triage.Jason Randhawa, Chantelle T. Hrazdil, Patrick J. McDonald & Judy Illes - 2023 - Journal of Medical Ethics 49 (2):81-86.
    Electroencephalographic monitoring provides critical diagnostic and management information about patients with epilepsy and seizure mimics. Admission to an epilepsy monitoring unit (EMU) is the gold standard for such monitoring in major medical facilities worldwide. In many countries, access can be challenged by limited resources compared to need. Today, triaging admission to such units is generally approached by unwritten protocols that vary by institution. In the absence of explicit guidance, decisions can be ethically taxing and are easy to challenge. In an (...)
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  210.  5
    Green prescribing is good, but patients do not have a duty to accept it.Travis N. Rieder - 2023 - Journal of Medical Ethics 49 (2):104-105.
    Joshua Parker’s article on green inhaler prescribing is important and timely. I agree with much of it, specifically regarding the institutional duty to make climate-friendly changes (from environmentally expensive prescriptions to ‘greener,’ similarly effective ones). The challenge, however, comes in determining how that institutional obligation impacts the rights and duties of patients. In this commentary, I want to offer a friendly alternative to Parker’s view of individual patient obligation, which I suggest is important for reasons that go beyond this one (...)
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  211. Orphans Cannot be After-Birth Aborted: A Response to Bobier.Prabhpal Singh - 2023 - Journal of Medical Ethics 49 (2):143-144.
    I offer a response to an objection to my account of the moral difference between fetuses and newborns, an account that seeks to address an analogy between abortion and infanticide which is based on the apparent equality of moral value of fetuses and newborns.
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  212. My body, still my choice: an objection to Hendricks on abortion.Kyle van Oosterum - 2023 - Journal of Medical Ethics 49 (2):145-145.
    In ‘My body, not my choice: against legalised abortion’, Hendricks offers an intriguing argument that suggests the state can coerce pregnant women into continuing to sustain their fetuses. His argument consists partly in countering Boonin’s defence of legalised abortion, followed by an argument from analogy. I argue in this response article that his argument from analogy fails and, correspondingly, it should still be a woman’s legal choice to have an abortion. My key point concerns the burdensomeness of pregnancy which is (...)
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  213.  9
    Clinical challenges to the concept of ectogestation.Phillip S. Wozniak - 2023 - Journal of Medical Ethics 49 (2):115-120.
    Since the publication of the successful animal trials of the Biobag, a prototypical extrauterine support for extremely premature neonates, numerous ethicists have debated the potential implications of such a device. Some have argued that the Biobag represents a natural evolution of traditional newborn intensive care, while others believe that the Biobag would create a new class of being for the patients housed within. Kingma and Finn argued inBioethicsfor making a categorical distinction between fetuses, newborns and ‘gestatelings’ in a Biobag on (...)
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  214.  73
    Ethics of generative AI.Hazem Zohny, John McMillan & Mike King - 2023 - Journal of Medical Ethics 49 (2):79-80.
    Artificial intelligence (AI) and its introduction into clinical pathways presents an array of ethical issues that are being discussed in the JME. 1–7 The development of AI technologies that can produce text that will pass plagiarism detectors 8 and are capable of appearing to be written by a human author 9 present new issues for medical ethics. One set of worries concerns authorship and whether it will now be possible to know that an author or student in fact produced submitted (...)
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  215.  55
    Abortion policies at the bedside: a response.Bruce Philip Blackshaw - 2023 - Journal of Medical Ethics 1 (12):852-853.
    Hersey et al have outlined a proposed ethical framework for assessing abortion policies that locates the effect of government legislation between the provider and the patient, emphasising its influence on interactions between them. They claim that their framework offers an alternative to the personal moral claims that lie behind legislation restricting abortion access. However, they fail to observe that their own understanding of reproductive justice and the principles of medical ethics are similarly predicated on their individual moral beliefs. Consequently, the (...)
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  216.  13
    Diversity and inclusion for rodents: how animal ethics committees can help improve translation.Piotrowska Monika - 2023 - Journal of Medical Ethics 1.
    Translation failure occurs when a treatment shown to be safe and effective in one type of population does not produce the same result in another. We are currently in a crisis involving the translatability of preclinical studies to human populations. Animal trials are no better than a coin toss at predicting the safety and efficacy of drugs in human trials, and the high failure rate of drugs entering human trials suggests that most of the suffering of laboratory animals is futile, (...)
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  217.  2
    Fetal Reduction, Moral Permissibility and the All or Nothing Problem.Xueshi Wang - 2023 - Journal of Medical Ethics (11):772-775.
    There is an ongoing debate about whether multifetal pregnancy reduction from twins to singletons (2-to-1 MFPR) is morally permissible. By applying the all or nothing problem to the cases of reducing twin pregnancies to singletons, Räsänen argues that an implausible conclusion seems to follow from two plausible claims: (1) it is permissible to have an abortion and (2) it is wrong to abort only one fetus in a twin pregnancy. The implausible conclusion is that women considering 2-to-1 MFPR for social (...)
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  218.  50
    Caring as the unacknowledged matrix of evidence-based nursing.Victoria Min-Yi Wang & Brian Baigrie - 2023 - Journal of Medical Ethics.
    In this article, we explicate evidence-based nursing (EBN), critically appraise its framework and respond to nurses’ concern that EBN sidelines the caring elements of nursing practice. We use resources from care ethics, especially Vrinda Dalmiya’s work that considers care as crucial for both epistemology and ethics, to show how EBN is compatible with, and indeed can be enhanced by, the caring aspects of nursing practice. We demonstrate that caring can act as a bridge between ‘external’ evidence and the other pillars (...)
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  219.  7
    Justification of principles for healthcare priority setting: the relevance and roles of empirical studies exploring public values.Erik Gustavsson & Lars Lindblom - 2023 - Journal of Medical Ethics.
    How should scarce healthcare resources be distributed? This is a contentious issue that became especially pressing during the pandemic. It is often emphasised that studies exploring public views about this question provide valuable input to the issue of healthcare priority setting. While there has been a vast number of such studies it is rarely articulated, more specifically, what the results from these studies would mean for the justification of principles for priority setting. On the one hand, it seems unreasonable that (...)
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  220.  10
    Understanding genetic justice in the post-enhanced world: a reply to Sinead Prince.Jon Rueda - 2023 - Journal of Medical Ethics.
    In her recent article, Prince has identified a critical challenge for those who advocate genetic enhancement to reduce social injustices. The gene–environment interaction prevents genetic enhancement from having equitable effects at the phenotypic level, even if enhancement were available to the entire population. The poor would benefit less than the rich from their improved genes because their genotypes would interact with more unfavourable socioeconomic environments. Therefore, Prince believes that genetic enhancement should not be used to combat social inequalities, since it (...)
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  221.  3
    Against tiebreaking arguments in priority setting.Borgar Jolstad & Erik Gustavsson - 2023 - Journal of Medical Ethics.
    Fair priority setting is based on morally sound criteria. Still, there will be cases when these criteria, our primary considerations, are tied and therefore do not help us in choosing one allocation over another. It is sometimes suggested that such cases can be handled by tiebreakers. In this paper, we discuss two versions of tiebreakers suggested in the literature. One version is to preserve fairness or impartiality by holding a lottery. The other version is to allow secondary considerations, considerations that (...)
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