Biomedical Ethics

Edited by L. Syd M Johnson (SUNY Upstate Medical University)
Assistant editor: Tyler John (Rutgers University - New Brunswick)
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  1. Allocation of COVID-19 Vaccination: When Public Prioritisation Preferences Differ From Official Regulations.Philipp Sprengholz, Lars Korn, Sarah Eitze & Cornelia Betsch - forthcoming - Journal of Medical Ethics:medethics-2021-107339.
    As vaccines against COVID-19 are scarce, many countries have developed vaccination prioritisation strategies focusing on ethical and epidemiological considerations. However, public acceptance of such strategies should be monitored to ensure successful implementation. In an experiment with N=1379 German participants, we investigated whether the public’s vaccination allocation preferences matched the prioritisation strategy approved by the German government. Results revealed different allocations. While the government had top-prioritised vulnerable people, participants preferred exclusive allocation of the first available vaccines to medical staff and personnel (...)
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  2. Ethical Considerations for Protecting the Options of Subjects in Primary Epidemic Vaccine Trials.Arthur L. Caplan & Jerrold L. Abraham - 2021 - Journal of Medical Ethics 47 (5):360-360.
    The recent review by Monrad1 presents several issues about secondary vaccine trials. It lays out the case in which a vaccine has been tested through phases I–III and is being deployed. Subsequently, consideration is being given to conducting ‘trials for another vaccine for the pathogen’. Monrad states: ‘In summary, we may say that researchers have strong prima facie reasons not to conduct a secondary vaccine trial.’ Monrad discusses several factors meriting careful consideration about the need for developing and testing more (...)
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  3. Imperfect by Design: The Problematic Ethics of Surgical Training.Connor Brenna & Sunit Das - 2021 - Journal of Medical Ethics 47 (5):350-353.
    There exists in academic medicine a core ethical issue that is seldom pursued: trainees are frequently not the best person in the operating room at a given intervention being performed, and yet as a profession we understand a fundamental need to afford them opportunities to perform. Academic centres are traditionally associated with a higher quality of care than non-academic centres, suggesting that practical measures exist within teaching hospitals that effectively mask the clinical discrepancies between trainees and their preceptors. Nonetheless, we (...)
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  4. Is One Narrative Enough? Analytical Tools Should Match the Problems They Address.Nathan Hodson & Susan Bewley - 2021 - Journal of Medical Ethics 47 (5):357-359.
    Jeff Nisker describes his personal experience of a diagnosis of advanced prostate cancer and the kindnesses he received from friendly doctors. He claims that this narrative account supports the promotion of Prostate Specific Antigen screening for asymptomatic men and impugns statisticians, mistakenly thinking that their opposition to PSA screening derives from concerns about financial cost. The account inadvertently demonstrates the danger of over-reliance on a single ethical tool for critical analysis. In the first part of this response, we describe the (...)
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  5. In Defence of Gestatelings: Response to Colgrove.Elselijn Kingma - 2021 - Journal of Medical Ethics 47 (5):355-356.
    Ectogestation—that is, ‘artificial’ or extramammalian pregnancy—may soon be within technological reach. This confronts us with questions about the correct moral and legal attitude towards the subjects of this technology, which are called ‘gestatelings’. Colgrove argues that gestatelings are a kind of newborn, and consequently should have the same moral and legal protections as newborns. This paper responds that both claims are unsupported by his arguments, which equivocate on two understandings of the term ‘newborn’. Questions about the appropriate moral and legal (...)
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  6. Transparent AI: Reliabilist and Proud.Abhishek Mishra - 2021 - Journal of Medical Ethics 47 (5):341-342.
    Durán et al argue in ‘Who is afraid of black box algorithms? On the epistemological and ethical basis of trust in medical AI’1 that traditionally proposed solutions to make black box machine learning models in medicine less opaque and more transparent are, though necessary, ultimately not sufficient to establish their overall trustworthiness. This is because transparency procedures currently employed, such as the use of an interpretable predictor,2 cannot fully overcome the opacity of such models. Computational reliabilism, an alternate approach to (...)
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  7. Process of Risk Assessment by Research Ethics Committees: Foundations, Shortcomings and Open Questions.Pranab Rudra & Christian Lenk - 2021 - Journal of Medical Ethics 47 (5):343-349.
    Risks and burdens in the study participation, as well as an adequate risk-benefit balance, are key concepts for the evaluation of clinical studies by research ethics committees. An adequate assessment and continuous monitoring to ensure compliance of risks and burdens in clinical trials have long been described as a central task in research ethics. However, there is currently no uniform and solid theoretical approach to risk assessment by RECs. Regulatory standards of research ethics such as the Declaration of Helsinki provide (...)
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  8. Gender Dysphoria in Adolescents: Can Adolescents or Parents Give Valid Consent to Puberty Blockers?Simona Giordano, Fae Garland & Soren Holm - 2021 - Journal of Medical Ethics 47 (5):324-328.
    This article considers the claim that gender diverse minors and their families should not be able to consent to hormonal treatment for gender dysphoria. The claim refers particularly to hormonal treatment with so-called ‘blockers’, analogues that suspend temporarily pubertal development. We discuss particularly four reasons why consent may be deemed invalid in these cases: the decision is too complex; the decision-makers are too emotionally involved; the decision-makers are on a ‘conveyor belt’; the possibility of detransitioning. We examine each of these (...)
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  9. Trustworthy Medical AI Systems Need to Know When They Don’T Know.Thomas Grote - 2021 - Journal of Medical Ethics 47 (5):337-338.
    There is much to learn from Durán and Jongsma’s paper.1 One particularly important insight concerns the relationship between epistemology and ethics in medical artificial intelligence. In clinical environments, the task of AI systems is to provide risk estimates or diagnostic decisions, which then need to be weighed by physicians. Hence, while the implementation of AI systems might give rise to ethical issues—for example, overtreatment, defensive medicine or paternalism2—the issue that lies at the heart is an epistemic problem: how can physicians (...)
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  10. Concerning a Seemingly Intractable Feature of the Accountability Gap.Benjamin Lang - 2021 - Journal of Medical Ethics 47 (5):336-336.
    The authors put forward an interesting response to detractors of black box algorithms. According to the authors, what is of ethical relevance for medical artificial intelligence is not so much their transparency, but rather their reliability as a process capable of producing accurate and trustworthy results. The implications of this view are twofold. First, it is permissible to implement a black box algorithm in clinical settings, provided the algorithm’s epistemic authority is tempered by physician expertise and consideration of patient autonomy. (...)
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  11. Balancing Health Worker Well-Being and Duty to Care: An Ethical Approach to Staff Safety in COVID-19 and Beyond.Rosalind J. McDougall, Lynn Gillam, Danielle Ko, Isabella Holmes & Clare Delany - 2021 - Journal of Medical Ethics 47 (5):318-323.
    The COVID-19 pandemic has highlighted the risks that can be involved in healthcare work. In this paper, we explore the issue of staff safety in clinical work using the example of personal protective equipment in the COVID-19 crisis. We articulate some of the specific ethical challenges around PPE currently being faced by front-line clinicians, and develop an approach to staff safety that involves balancing duty to care and personal well-being. We describe each of these values, and present a decision-making framework (...)
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  12. Public Health Decisions in the COVID-19 Pandemic Require More Than ‘Follow the Science’.Thana Cristina de Campos-Rudinsky & Eduardo Undurraga - 2021 - Journal of Medical Ethics 47 (5):296-299.
    Although empirical evidence may provide a much desired sense of certainty amidst a pandemic characterised by uncertainty, the vast gamut of available COVID-19 data, including misinformation, has instead increased confusion and distrust in authorities’ decisions. One key lesson we have been gradually learning from the COVID-19 pandemic is that the availability of empirical data and scientific evidence alone do not automatically lead to good decisions. Good decision-making in public health policy, this paper argues, does depend on the availability of reliable (...)
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  13. National Health System Cuts and Triage Decisions During the COVID-19 Pandemic in Italy and Spain: Ethical Implications.Maurizio P. Faggioni, Fermín Jesús González-Melado & Maria Luisa Di Pietro - 2021 - Journal of Medical Ethics 47 (5):300-307.
    In this paper, we analyse the most important documents establishing the criteria for the treatment and exclusion of COVID-19 patients, especially in regard to the giving of respiratory support, in Italy and Spain. These documents reflect a tension that stems from limited healthcare resources which are insufficient to save lives that, under normal conditions, could have been saved, or at least could have received the best possible treatment. First, we analyse the healthcare systems of these two countries before the spread (...)
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  14. Should Age Matter in COVID-19 Triage? A Deliberative Study.Margot N. I. Kuylen, Scott Y. Kim, Alexander Ruck Keene & Gareth S. Owen - 2021 - Journal of Medical Ethics 47 (5):291-295.
    The COVID-19 pandemic put a large burden on many healthcare systems, causing fears about resource scarcity and triage. Several COVID-19 guidelines included age as an explicit factor and practices of both triage and ‘anticipatory triage’ likely limited access to hospital care for elderly patients, especially those in care homes. To ensure the legitimacy of triage guidelines, which affect the public, it is important to engage the public’s moral intuitions. Our study aimed to explore general public views in the UK on (...)
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  15. Triage, Consent and Trusting Black Boxes.Kenneth Boyd - 2021 - Journal of Medical Ethics 47 (5):289-290.
    The coronavirus pandemic has brought to public attention a variety of questions long debated in medical ethics, but now given both added urgency and wider publicity. Among these is triage, with its origins in deciding which individual lives are to be saved on a battlefield, but now also concerned with the allocation of scarce resources more generally. On the historical battlefield, decisions about whom to treat first – neither those who would survive without treatment, nor those who would not survive (...)
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  16. Why Have Uniform Informed Consent Documents When the Research Volunteers Are So Diverse?Ross E. McKinney Jr - 2021 - American Journal of Bioethics 21 (5):59-60.
    Making consent work for its primary purposes has been, and will be, a challenge. Millum and Bromwich have done an excellent job of considering the manifold obligations of informed consent, with the...
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  17. Rationalizing Resources for Disorders of Consciousness Care.Jeroen Luyten - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):142-143.
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  18. Why Moral Enhancement is Unavoidably Normative.Paul Rezkalla - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):105-106.
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  19. The Development of Self-Trust in DBS Patients.Ashley E. Walton - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):194-196.
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  20. Moral Enhancement Frameworks and Narrative Identity.Marcos Alonso - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):112-114.
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  21. Losing Our (Moral) Self in the Moral Bioenhancement Debate.Fabrice Jotterand - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):87-88.
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  22. A Misguided yet Informative Approach.Nicolai Wohns - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):119-121.
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  23. Precautionary Personhood: We Should Treat Patients with Disorders of Consciousness as Persons.Matthew Braddock - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):162-164.
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  24. Responsibility, Authenticity and the Self in the Case of Symbiotic Technology.Giulio Mecacci & W. F. G. Haselager - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):196-198.
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  25. Mapping the Dimensions of Agency: The Narrative as Unifying Mechanism.Przemysław Zawadzki - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):191-193.
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  26. What’s So Great About Consciousness?Charles Foster - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):140-142.
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  27. A Closer Look at the Adequacy of Proposed Frameworks for a “Virtue Theory for Moral Enhancement”.John A. Johnson - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):103-105.
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  28. Identity, Virtue Theory, and the Death of Moral Enhancement.Davide Battisti & Federico Bina - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):114-116.
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  29. Mapping the Other Side of Agency.Nikolai Münch, Nils-Frederic Wagner & Norbert W. Paul - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):198-200.
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  30. Operationalizing Agency in Brain Computer Interface (BCI) Research.Kristin Kostick, Peter Zuk & Gabriel Lázaro-Muñoz - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):203-205.
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  31. Enhancing Virtue Without Becoming Ned Flanders?Jon Rueda - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):121-124.
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  32. Patients with Disorders of Consciousness in the Real World.Lois Shepherd - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):144-145.
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  33. In Pursuit of Agency Ex Machina: Expanding the Map in Severe Brain Injury.Joseph J. Fins, Megan S. Wright, Joseph T. Giacino, Jaimie Henderson & Nicholas D. Schiff - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):200-202.
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  34. DoC and COVID Vaccinations: A Complex Decision.Joaquín Hortal-Carmona & Gonzalo Díaz-Cobacho - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):154-156.
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  35. Challenges and Opportunities of Creating Conceptual Maps.Laura Y. Cabrera & Robyn Bluhm - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):187-189.
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  36. Empiricism and Rights Justify the Allocation of Health Care Resources to Persons with Disorders of Consciousness.Joseph T. Giacino, Yelena G. Bodien, David Zuckerman, Jaimie Henderson, Nicholas D. Schiff & Joseph J. Fins - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):169-171.
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  37. Can Moral Enhancement Address Our Environmental Crisis? A Call for Collective Virtue-Oriented Action.Brooke Burns, Nicolae Morar, Rebekah Sinclair & Kirstin Waldkoenig - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):124-126.
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  38. Prospective Benefit Plus Moral Status: A Hybrid Model.Peter Maloy Koch - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):146-148.
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  39. Dimensions of Agency: Conceptual and Data-Driven Approaches.Adina L. Roskies - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):189-191.
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  40. Emerging Consciousness at a Clinical Crossroads.Michael J. Young & Brian L. Edlow - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):148-150.
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  41. Disorders of Consciousness and Theories of Well-Being.Peter Zuk - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):165-167.
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  42. The Rhythms of Virtue.Grant R. Gillett - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):110-112.
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  43. Enhancing Fabiano’s Virtue Theory for Moral Enhancement.Vojin Rakić - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):108-110.
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  44. Moral Enhancement Where It Would Make the Most Difference.Tamara Kayali Browne - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):107-108.
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  45. The Evolving Science of Disorders of Consciousness Calls for an Inclusive Framework for Healthcare Resource Allocation.Jasmine Walter - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):151-153.
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  46. Virtue Theory for Moral Enhancement.Joao Fabiano - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):89-102.
    Our present moral traits are unable to provide the level of large-scale co-operation necessary to deal with risks such as nuclear proliferation, drastic climate change and pandemics. In order to survive in an environment with powerful and easily available technologies, some authors claim that we need to improve our moral traits with moral enhancement. But this is prone to produce paradoxical effects, be self-reinforcing and harm personal identity. The risks of moral enhancement require the use of a safety framework; such (...)
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  47. The Cost of Compassion: Resource Allocation and Disorders of Consciousness.Mackenzie Graham - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):159-162.
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  48. Should We Trust Patient-Reported Outcomes?Marie-Christine Nizzi - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):156-159.
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  49. What Justifies the Allocation of Health Care Resources to Patients with Disorders of Consciousness?Andrew Peterson, Sean Aas & David Wasserman - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):127-139.
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  50. Mapping the Dimensions of Agency.Andreas Schönau, Ishan Dasgupta, Timothy Brown, Erika Versalovic, Eran Klein & Sara Goering - 2021 - American Journal of Bioethics Neuroscience 12 (2-3):172-186.
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