Biomedical Ethics, Misc

En este trabajo se comparan dos representaciones en competencia sobre el origen de la bioética para llamar la atención sobre un posible cambio de marco teórico dentro de la disciplina. Por un lado, una representación parroquiana del origen de la bioética, centrada en problemas tecnológicos locales, y fundamentada en tradiciones culturales particulares. Por otro lado, una representación universal y pluralista, que enfrenta problemas de justicia y salud globales y que intenta buscar el fundamento normativo del discurso de la bioética en (...) los derechos humanos. Luego de compararlas, desarrollo algunas razones para mostrar por qué las relaciones entre bioética y derechos humanos están sólidamente justificadas. Por último, planteo dos observaciones críticas que deberían tenerse en cuenta al pensar la relación entre bioética y derechos humanos. (shrink)

Type 1 diabetes (T1D) is a chronic illness that requires intensive lifelong management of blood glucose concentrations by means of external insulin administration. There have been substantial developments in the ways of measuring glucose levels, which is crucial to T1D self-management. Recently, continuous glucose monitoring (CGM) has allowed people with T1D to keep track of their blood glucose levels in near real-time. These devices have alarms that warn users about potentially dangerous blood glucose trends, which can often be shared with (...) ther people. CGM is consistently associated with improved glycemic control and reduced hypoglycemia and is currently recommended by doctors. However, due to the costs of CGM, only those who qualify for hospital provision or those who can personally afford it are able to use it, which excludes many people. In this paper, I argue that unequal access to CGM results in: (1) unjust health inequalities, (2) relational injustice, (3) injustice with regard to agency and autonomy, and (4) epistemic injustice. These considerations provide prima facie moral reasons why all people with T1D should have access to CGM technology. I discuss the specific case of CGM policy in the Netherlands, which currently only provides coverage for a small group of people with T1D, and argue that, especially with additional considerations of cost-effectiveness, the Dutch government ought to include CGM in basic health care insurance for all people with T1D. (shrink)

En este trabajo se comparan dos representaciones en competencia sobre el origen de la bioética para llamar la atención sobre un posible cambio de marco teórico dentro de la disciplina. Por un lado, una representación parroquiana del origen de la bioética, centrada en problemas tecnológicos locales, y fundamentada en tradiciones culturales particulares. Por otro lado, una representación universal y pluralista, que enfrenta problemas de justicia y salud globales y que intenta buscar el fundamento normativo del discurso de la bioética en (...) los derechos humanos. Luego de compararlas, desarrollo algunas razones para mostrar por qué las relaciones entre bioética y derechos humanos están sólidamente justificadas. Por último, planteo dos observaciones críticas que deberían tenerse en cuenta al pensar la relación entre bioética y derechos humanos. (shrink)

Rapidly advancing technologies in the field of extracorporeal cardiopulmonary resuscitation (ECPR) have presented a new challenge in accurate neuroprognostication following cardiac arrest. Determination of brain state informs the prognostic picture and allows providers to begin effective communication regarding likelihood of meaningful neurological recovery as defined by patients or family members. The evolving role of sedation during ECPR and its impacts on ethical tension in decision-making is reviewed. Work surrounding the advancing field of neuroprognostication after cardiac arrest and hypothermia is summarized (...) and implications of premature withdrawal of life-sustaining treatments are discussed. Advances that improve predictive value for neurological recovery are utilized in affirming and discussing the implications for end-of-life wishes of individuals in the setting of intensive resuscitative therapies. (shrink)

Whenever the government makes medical resource allocation choices, there will be opportunity costs associated with those choices: some patients will have treatment and live longer, while a different group of patients will die prematurely. Because of this, we have to make sure that the benefits we get from investing in treatment A are large enough to justify the benefits forgone from not investing in the next best alternative, treatment B. There has been an increase in spending and reallocation of resources (...) during the COVID-19 pandemic that may have been warranted given the urgency of the situation. However, these actions do not bypass the opportunity cost principle although they can appear to in the short term, since spending increases cannot continue indefinitely and there are patient groups who lose out when resources are redirected to pandemic services. Therefore, policy-makers must consider who bears the cost of the displaced healthcare resources. Failure to do so runs a risk of reducing overall population health while disproportionally worsening health in socially disadvantaged groups. We give the example of ethnic minorities in England who already had the worst health and, due to structural injustices, were hardest hit by the pandemic and may stand to lose the most when services are reallocated to meet the resource demands of the crisis. How can we prevent this form of health inequity? Our proposal is forward-looking: we suggest that the government should invest our resources wisely while taking issues of equity into account–that is, introduce cost–equity analysis. (shrink)

Hematopoietic stem cell transplantation is a widely accepted practice in the United Kingdom (UK). The relatively liberal UK law permits donation both within families and from strangers, and even allows the creation of “saviour siblings” who are brought into being with the specific intent of having them donate stem cells to save other members of their family. This chapter describes the regulation of HSCT in the UK and highlights some ethical issues related to discrimination against some categories of potential donors, (...) the accuracy of the information provided to potential donors, and the controversy concerning saviour siblings. (shrink)

This book offers new essays exploring concepts and applications of nonideal theory in bioethics. Nonideal theory refers to an analytic approach to moral and political philosophy (especially in relation to justice), according to which we should not assume that there will be perfect compliance with principles, that there will be favorable circumstances for just institutions and right action, or that reasoners are capable of being impartial. Nonideal theory takes the world as it actually is, in all of its imperfections. Bioethicists (...) have called for greater attention to how nonideal theory can serve as a guide in the messy realities they face daily. Although many bioethicists implicitly assume nonideal theory in their work, there is the need for more explicit engagement with this theoretical outlook. A nonideal approach to bioethics would start by examining the sociopolitical realities of healthcare and the embeddedness of moral actors in those realities. How are bioethicists to navigate systemic injustices when completing research, giving guidance for patient care, and contributing to medical and public health policies? When there are no good options and when moral agents are enmeshed in their sociopolitical viewpoints, how should moral theorizing proceed? What do bioethical issues and principles look like from the perspective of historically marginalized persons? These are just a few of the questions that motivate nonideal theory within bioethics. This book begins in Part I with an overview of the foundational tenets of nonideal theory, what nonideal theory can offer bioethics, and why it may be preferable to ideal theory in addressing moral dilemmas in the clinic and beyond. In Part II, authors discuss applications of nonideal theory in many areas of bioethics, including reflections on environmental harms, racism and minority health, healthcare injustices during incarceration and detention, and other vulnerabilities experienced by patients from clinical and public health perspectives. The chapters within each section demonstrate the breadth in scope that nonideal theory encompasses, bringing together diverse theorists and approaches into one collection. (shrink)

Pro-life advocates commonly argue that fetuses have the moral status of persons, and an accompanying right to life, a view most pro-choice advocates deny. A difficulty for this pro-life position has been Judith Jarvis Thomson’s violinist analogy, in which she argues that even if the fetus is a person, abortion is often permissible because a pregnant woman is not obliged to continue to offer her body as life support. Here, we outline the moral theories underlying public health ethics, and examine (...) the COVID-19 pandemic as an example of public health considerations overriding individual rights. We argue that if fetuses are regarded as persons, then abortion is of such prevalence in society that it also constitutes a significant public health crisis. We show that on public health considerations, we are justified in overriding individual rights to bodily autonomy by prohibiting abortion. We conclude that in a society that values public health, abortion can only be tolerated if fetuses are not regarded as persons. (shrink)

Brian Earp’s and Julian Savulescu’s provocatively titled “Love Drugs: The Chemical Future of Relationships” is a philosophically rigorous, scientifically informed, and yet wholly accessible study o...

Double Effect Donation claims it is permissible for a person meeting brain death criteria to donate vital organs, even though such a person may be alive. The reason this act is permissible is that it does not aim at one’s own death but rather at saving the lives of others, and because saving the lives of others constitutes a proportionately serious reason for engaging in a behavior in which one foresees one’s death as the outcome. Double Effect Donation, we argue, (...) opens a novel position in debates surrounding brain death and organ donation, and does so without compromising the sacredness and fundamental equality of human life. (shrink)

Bioethical work on solidarity has yielded an array of divergent conceptions. But what do these accounts add to normative bioethics? What is solidarity’s distinctive social normative role? Prainsack and Buyx suggest that solidarity be understood as the ‘putty’ of justice. I argue here that the putty metaphor is deeply insightful and—when spelled out in detail—successfully explicates solidarity’s social normative function. Unfortunately, Prainsack and Buyx’s own account cannot play this role. I propose instead that the putty metaphor supports a conception of (...) solidarity as equity. This proposal enables us to answer whether and when we should act in solidarity, and with whom, while also capturing the putty metaphor and hence answering a basic question: what is solidarity for? (shrink)

Biomarker-based predictive tests for subjectively asymptomatic Alzheimer’s disease (AD) are utilized in research today. Novel applications of artificial intelligence (AI) promise to predict the onset of AD several years in advance without determining biomarker thresholds. Until now, little attention has been paid to the new ethical challenges that AI brings to the early diagnosis in asymptomatic individuals, beyond contributing to research purposes, when we still lack adequate treatment. The aim of this paper is to explore the ethical arguments put forward (...) for AI aided AD prediction in subjectively asymptomatic individuals and their ethical implications. The ethical assessment is based on a systematic literature search. Thematic analysis was conducted inductively of 18 included publications. The ethical framework includes the principles of autonomy, beneficence, non-maleficence, and justice. Reasons for offering predictive tests to asymptomatic individuals are the right to know, a positive balance of the risk-benefit assessment, and the opportunity for future planning. Reasons against are the lack of disease modifying treatment, the accuracy and explicability of AI aided prediction, the right not to know, and threats to social rights. We conclude that there are serious ethical concerns in offering early diagnosis to asymptomatic individuals and the issues raised by the application of AI add to the already known issues. Nevertheless, pre-symptomatic testing should only be offered on request to avoid inflicted harm. We recommend developing training for physicians in communicating AI aided prediction. (shrink)

We argue that while digital health technologies (e.g. artificial intelligence, smartphones, and virtual reality) present significant opportunities for improving the delivery of healthcare, key concepts that are used to evaluate and understand their impact can obscure significant ethical issues related to patient engagement and experience. Specifically, we focus on the concept of empowerment and ask whether it is adequate for addressing some significant ethical concerns that relate to digital health technologies for mental healthcare. We frame these concerns using five key (...) ethical principles for AI ethics (i.e. autonomy, beneficence, non-maleficence, justice, and explicability), which have their roots in the bioethical literature, in order to critically evaluate the role that digital health technologies will have in the future of digital healthcare. (shrink)

Thaler and Sunstein advocate 'libertarian paternalism'. A libertarian paternalist changes the conditions under which people act so that their cognitive biases lead them to choose what is best for themselves. Although libertarian paternalism manipulates people, Thaler and Sunstein say that it respects their autonomy by preserving the possibility of choice. Conly argues that libertarian paternalism does not go far enough, since there is no compelling reason why we should allow people the opportunity to choose to bring disaster upon themselves if (...) sometimes they will make the wrong decision. She defends 'coercive paternalism'. The present paper argues that errors in reasoning are not due only to cognitive biases. People also make errors because they have an insufficient level of general intelligence. Intelligence is distributed on a continuum. Those who fall on higher levels of the continuum have greater abilities, in certain contexts, to reason about both their own and others' interests. Coercive paternalism may sometimes be appropriate to prevent less intelligent people from engaging in self-destructive behavior due to errors of reasoning. (shrink)

Preventive vaccination can protect not just vaccinated individuals, but also others, which is often a central point in discussions about vaccination. To date, there has been no systematic study of self- and other-directed motives behind vaccination. This article has two major goals: first, to examine and distinguish between self- and other-directed motives behind vaccination, especially with regard to vaccinating for the sake of third parties, and second, to explore some ways in which this approach can help to clarify and guide (...) vaccination debates and policy. I propose conceiving of vaccination in terms of three basic elements: the vaccination decision-maker, the vaccine recipient and the primary beneficiary. I develop a taxonomy based on the relations between these elements to distinguish four kinds of vaccination: self-protective, paternalistic, altruistic and indirect. I finally discuss the case of human papillomavirus vaccine regulation for men and women to show how each kind of vaccination is associated with and raises specific ethical questions. (shrink)

BOOK REVIEW: John McMillan, THE METHODS OF BIOETHICS: AN ESSAY IN META- BIOETHICS Oxford University Press, 2018 ISBN-13: 978-0199603756 ISBN-10: 0199603758.

The central concerns of Hutchison’s paper are the under-representation and unequal pay of women in surgery and the role that subtle gender biases play in explaining these phenomena. My comments focus on how well executed and important this work is and also why we need more of it to fully understand the gravity of the situation for women in surgery and how it compares with similar situations for women in other fields.

Care is more than dispensing pills or cleaning beds. It is about responding to the entire patient. What is called “bedside manner” in medical personnel is a quality of treating the patient not as a mechanism but as a being—much like the caregiver—with desires, ideas, dreams, aspirations, and the gamut of mental and emotional character. As automata, answering an increasing functional need in care, are designed to enact care, the pressure is on their becoming more humanlike to carry out the (...) function more effectively. The question becomes not merely whether the care automaton can effect good bedside manner but whether the patient’s response is not feeling deceived by the humanlikeness. It seems the device must be designed either to effect explicit mere human-“likeness,” thus likely undermining its bedside-manner potential, or to fool the patient completely. Neither option is attractive. This article examines the social problems of designing maximally humanlike care automata and how problems may start to erode the human rights of users/patients. The article then investigates the alternatives for dealing with this problem, whether by industrial and professional self-regulation or public-policy initiatives. It then frames the problem in the broader historical perspective in terms of previous bans, moratoria, and other means of control of hazardous and potentially rights-violating techniques and materials. (shrink)

It has recently been argued that reproductive genetic manipulation technologies like mitochondrial replacement and germline CRISPR modifications cannot be said to save anyone’s life because, counterfactually, no one would suffer more or die sooner absent the intervention. The present article argues that, on the contrary, reproductive genetic manipulations may be life-saving (and, from this, have therapeutic value) under an appropriate population health perspective. As such, popular reports of reproductive genetic manipulations potentially saving lives or preventing disease are not necessarily mistaken, (...) though such terminology still requires further empirical validation. (shrink)

Volume 26, Issue 3, September 2020, Page 195-196.

The term “value of life” can refer to life’s intrinsic dignity: something nonincremental and time-unaffected in contrast to the fluctuating, incremental “value” of our lives, as they are longer or shorter and more or less flourishing. Human beings are equal in their basic moral importance: the moral indignities we condemn in the treatment of e.g. those with dementia reflect the ongoing human dignity that is being violated. Indignities licensed by the person in advance remain indignities, as when people might volunteer (...) their living, unconscious bodies for surrogacy or training in amputation techniques. Respect for someone’s dignity is significantly impacted by a failure to value that person’s very existence, whatever genuine respect and good will is shown by wanting the person’s life to go well. Valuing and respecting life is not, however, vitalism: there can be good and compelling reasons for eschewing some means of prolonging life. (shrink)

In a recent article in this journal, Steve Clarke (2017) identifies two different bases for conscience-based refusals in healthcare: (1) all-things-considered moral judgments, and (2) the dictates of conscience. He argues that these two bases have distinct roles in justifying conscientious objection. However, accepting that there are these two bases, I argue that both are not able to justify conscientious objection. In particular, I argue that the second basis of the dictates of conscience cannot justify conscience-based refusal in a healthcare (...) context. Even if someone objects in a healthcare context on the basis of the dictates of her conscience, and even if we can explain why she objects with reference to the dictates of her conscience, her objection will only be justified if she makes a judgment. (shrink)

Would Aquinas hold the view that a patient in a persistent vegetative state (PVS) is something other than a human being? Some recent interpreters have argued for this position. I contend that this reading is grounded in a false symmetry between the three stages of Aquinas’s embryology and the (alleged) three-stage process of death. Instead, I show that there are textual grounds for rejecting the view that the absence of higher brain activity in a patient would lead Aquinas to say (...) that the patient no longer has a rational soul. On my reading of Aquinas, the patient in PVS has a rational soul and is unequivocally a human being. (shrink)

According to the Academy of Nutrition and Dietetics’ influential position statement on vegetarianism, meat and seafood can be replaced with milk, soy/legumes, and eggs without any negative effects in children. The United States Department of Agriculture endorses a similar view. The present paper argues that the Academy of Nutrition and Dietetics ignores or gives short shrift to direct and indirect evidence that vegetarianism may be associated with serious risks for brain and body development in fetuses and children. Regular supplementation with (...) iron, zinc, and B12 will not mitigate all of these risks. Consequently, we cannot say decisively that vegetarianism or veganism is safe for children. (shrink)

Recently, I argued that human subjects in artificial wombs (AWs) “share the same moral status as newborns” and so, deserve the same treatment and protections as newborns. This thesis rests on two claims: (A) “Subjects of partial ectogenesis—those that develop in utero for at time before being transferred to AWs—are newborns,” and (B) “Subjects of complete ectogenesis—those who develop in AWs entirely—share the same moral status as newborns.” In response, Elizabeth Chloe Romanis argued that the subject in an AW is (...) “a unique human entity…rather than a fetus or a newborn.” She provides four lines of response to my essay. First, she argues that I have “misconstrued” what birth is. Once we correct that error, it becomes clear that subjects of partial ectogenesis have not been born. Second, she argues that my claims imply that non-implanted embryos (existing in vivo) “would also be ‘born.’” But that is absurd. Third, she claims I fail to “meaningfully respond” to distinctions she draws between subjects of ectogenesis and neonates. Finally, she criticizes my essay for focusing on subjects of AWs rather than focusing on pregnant persons (who should be at the “centre” of debates over AWs). I respond to each of these charges. In doing so, I reaffirm that (contra Romanis) some subjects of ectogenesis are newborns and all subjects of ectogenesis—even those that have not been born—share the same moral status as newborns. (shrink)

Antimicrobial resistance (AMR) is a global public health disaster driven largely by antibiotic use in human health care. Doctors considering whether to prescribe antibiotics face an ethical conflict between upholding individual patient health and advancing public health aims. Existing literature mainly examines whether patients awaiting consultations desire or expect to receive antibiotic prescriptions, but does not report views of the wider public regarding conditions under which doctors should prescribe antibiotics. It also does not explore the ethical significance of public views (...) or their sensitivity to awareness of AMR risks or the standpoint (self-interested or impartial) taken by participants. Methods: An online survey was conducted with a sample of the U.S. public (n = 158). Participants were asked to indicate what relative priority should be given to individual patients and society-at-large from various standpoints and in various contexts, including antibiotic prescription. Results: Of the participants, 50.3% thought that doctors should generally prioritize individual patients over society, whereas 32.0% prioritized society over individual patients. When asked in the context of AMR, 39.2% prioritized individuals whereas 45.5% prioritized society. Participants were significantly less willing to prioritize society over individuals when they themselves were the patient, both in general (p = .001) and in relation to AMR specifically (p = .006). Conclusions: Participants’ attitudes were more oriented to society and sensitive to collective responsibility when informed about the social costs of antibiotic use and when considered from a third-person rather than first-person perspective. That is, as participants came closer to taking the perspective of an informed and impartial “ideal observer,” their support for prioritizing society increased. Our findings suggest that, insofar as antibiotic policies and practices should be informed by attitudes that are impartial and well-informed, there is significant support for prioritizing society. (shrink)

An analysis of media stories from Romanian newspapers on organ donation. Focus is placed on the ethical aspects of the stories.

This book makes an important contribution to ongoing efforts in the fields of medical law and bioethics to answer the challenges posed by the limitations of the principle of respect for autonomy, especially as these pertain to human research ethics. The principle of respect for autonomy seems to have become firmly embedded in human research ethics since its inclusion in the 1947 Nuremberg Code, which was a response to atrocities committed by Nazi doctors. Nonetheless, there is an increasing awareness of (...) the limitations of the principle of respect for autonomy and the underlying conceptualisations of human autonomy. (shrink)

This chapter examines the explicit and implicit roles that the concept of beneficence plays in the guidelines that govern biomedical research involving humans. We suggest that the role beneficence is actually playing in the guidelines is more comprehensive than is commonly assumed. The broader conceptualisation of beneficence proposed here clarifies the relationship of beneficence to respect for autonomy. It does this by showing how respect for autonomy is at the service of beneficence rather than in tension with it.

Volume 19, Issue 5, May 2019, Page 45-47.

This work titled "An Ethical Overview on Cloning in Nigeria" analyzed the debate on cloning for which many scholars believe that cloning is not just ethically and morally acceptable, but beneficial in that they allow otherwise infertile couples to have children and permit the study of genetic diseases and indeed genetic development. This work examined cloning from an ethical/moral perspective and held the view that there is everything inherently wrong with the idea of human cloning. As a scientific discovery, it (...) violates the dignity, respect, and value of human life and concluded that cloning coupled with its related procedures, placed the human offspring at risk of genuine harm. Also, it is shown that Cloned offspring's run the risk of misplaced or distorted genealogy. The work relied on library materials, analysis, critical exposition, and evaluative methods to achieve its objectives. (shrink)

This paper argues that epistemic errors rooted in group- or identity- based biases, especially those pertaining to disability, are undertheorized in the literature on medical error. After sketching dominant taxonomies of medical error, we turn to the field of social epistemology to understand the role that epistemic schemas play in contributing to medical errors that disproportionately affect patients from marginalized social groups. We examine the effects of this unequal distribution through a detailed case study of ableism. There are four primary (...) mechanisms through which the epistemic schema of ableism distorts communication between nondisabled physicians and disabled patients: testimonial injustice, epistemic overconfidence, epistemic erasure, and epistemic derailing. Measures against epistemic injustices in general and against schema-based medical errors in particular are ultimately issues of justice that must be better addressed at all levels of health care practice. (shrink)

While there is a prolific debate surrounding the issue of conscientious objection of individuals towards performing certain clinical acts, this debate ignores the fact that there are other reasons why clinicians might wish to object providing specific services. This paper briefly discusses the idea that healthcare workers might object to providing specific services because they are against their professional judgement, they want to maintain a specific reputation, or they have pragmatic reasons. Reputation here is not simply understood as being in (...) good standing with a professional body. Rather, reputation is treated in the sense that a craftsman might wish to be known for providing a specific type, quality, and style of service. Professionalism is understood as acting according to the philosophical and scientific principles that are the basis of healthcare (such as acting for the benefit of the patient’s health and following well- evidenced treatment pathways). (shrink)

This is the second edition of the textbook Bioethics in Canada. It is the most up to date bioethics textbook on the Canadian market. Twenty-nine of its 54 contributions are by Canadians. All the chapters carried over from the first edition are revised in full (especially the chapters on obligations to the global poor, on medical assistance in dying, and on public health). It comprises *new* chapters on emerging genetic technologies and on indigenous peoples' health. It contains *new* case studies (...) focusing on ethical issues and problems of relevance to Canadians. From the Preface: This anthology is designed for those teaching bioethics in colleges and universities in Canada. It comprises articles from researchers exploring the main problems of bioethics from a diversity of perspectives and ethical traditions. It includes in particular articles by Canadian researchers who appear in anthologies less often than they should. The hope is that the reader will, as a result, better appreciate the rich reservoir of talent present among those working in bioethics in Canada and Canadian bioethicists working abroad. In addition, this volume intentionally aims to educate the reader about the policies and laws regulating the most important and pressing bioethical problems facing Canadians. The hope is that the reader will develop a nuanced view of the nature, importance, and impact of bioethics in Canada. (shrink)

Our technological lifeworld has become an info-computational media populated by data and algorithms, an artificial environment for life and shared experiences. In this chapter, I tried to sketch three new assumptions for bioethics – it is hardly possible to substantiate ethical guidelines or an idea of normativity in an aprioristic manner; moral status is a function of data entities, not something solely human; agency is plural and thus is shared or sometimes delegated – in order to chart a proposal for (...) a posthuman bioethics. Posthuman is perhaps not the best expression available, but it covers the idea of a shift from a world centered on self-contained and exclusively human agency to a more comprehensive and relational way of thinking. The “posthuman” label should be understood as a rebuttal of biocentrism and anthropocentrism by moving closer to conceptions we encounter in population ethics or in discourse about biosocial and technical systems. Posthuman bioethics is “environmentalist” without losing the humanistic stance. The question regarding how suitable an infocentric bioethics is in practice remains to be settled. The moral principles in bioethics could be reconceived as relying on these new assumptions, in a postindividualistic manner that accepts formal primacy of causal digital artifacts in affording actions in a world of ambient algorithmic intelligence. (shrink)

While many books on ethics contain a chapter discussing prisoners’ rights and the ethical dimensions of research involving incarcerated persons, Vulnerability and Incarceration is the first monograph devoted to the subject. Victor interrogates the concept of vulnerability to examine prisoners’ right to medical research from a novel point of view.

Bioethicists sometimes defend compromise positions, particularly when they enter debates on applied topics that have traditionally been highly polarised, such as those regarding abortion, euthanasia and embryonic stem cell research. However, defending compromise positions is often regarded with a degree of disdain. Many are intuitively attracted to the view that it is almost always problematic to defend compromise positions, in the sense that we have a significant moral reason not to do so. In this paper, we consider whether this common (...) sense view can be given a principled basis. We first show how existing explanations for the problematic nature of compromise fall short of vindicating the common sense view, before offering our own explanation, which, we claim, comes closer to vindicating that view. We argue that defending a compromise will typically have two epistemic costs: it will corrupt attempts to use the claims of ethicists as testimonial evidence, and it will undermine standards that are important to making epistemic progress in ethics. We end by suggesting that the epistemic costs of compromise could be reduced by introducing a stronger separation between ethical debate aimed at fulfilling the epistemic role of ethics, and ethical debate that aims to directly produce good policy or practice. (shrink)

The concept of autonomy plays a central role in bioethics,1 but there is no consensus as to how we should understand it beyond a general notion of self-determination. The conception of autonomy deployed in applied ethics2 can have crucial ramifications when it is applied in real-world scenarios, so it is important to be clear. However, this clarity is often lacking when autonomy is discussed in the bioethics literature. In this paper we outline three different conceptions of autonomy, and argue that (...) a substantive, perfectionist approach meets the theoretical requirements for an account of autonomy and also provides practical guidance. As Rebecca Walker argues, bioethics requires a more conceptually adequate account... (shrink)

Douglas T. Going above and beneath the call ….

This document is designed to give guidance on assessing researchers in bioethics/medical ethics. It is intended to assist members of selection, confirmation and promotion committees, who are required to assess those conducting bioethics research when they are not from a similar disciplinary background. It does not attempt to give guidance on the quality of bioethics research, as this is a matter for peer assessment. Rather it aims to give an indication of the type, scope and amount of research that is (...) the expected in this field. It does not cover the assessment of other activities such as teaching, policy work, clinical ethics consultation and so on, but these will be mentioned for additional context. Although it mentions the UK’s Research Excellence Framework, it is not intended to be a detailed analysis of the place of bioethics in the REF. (shrink)

Se resaltan algunas peculiaridades sobre la manera como la Asociación Médica Mundial enfoca ciertos temas, ya que sus declaraciones y resoluciones reflejan cambios más o menos apreciables, que son manifiestos en los contenidos de ellas y orientan sus políticas. Se hace un comentario comparativo de las versiones de la Declaración de Ginebra de 1948 y 2017 con el Juramento hipocrático teniendo en cuenta las siguientes categorías: Carácter de la declaración; Tiempo verbal; Extensión en apotegmas o sentencias; núcleo epistémico; omisiones; innovaciones; (...) tipo de ethos. Las facultades de Medicina deberían incluir en sus currículos los acentos y contenidos convenientes para que el ethos hipocrático se conserve y la profesión médica pueda seguir gozando de la confianza, el respeto y el honor, que solo se mancillan cuando en la práctica profesional se cede terreno por intereses autónomos y economicistas. Como alternativa orientadora a las declaraciones de Ginebra se sugiere la versión creada por el Value of Life Committee, Inc. (shrink)

What kind of moral principle could be sufficiently restrictive to avoid the kind of large-scale risks that have resulted in catastrophe in the past, while at the same time not be so restrictive as to halt desirable progress? Is there such a principle that is not merely a precautionary principle, but one that could be based on firm moral grounds? In this article, I set out to explore a simple idea: might it be the case that reparability could serve as (...) a moral constraint against risky policy decisions? The idea is simple, but comes in two forms. First, that it is morally wrong to impose a risk for harm that is, in principle, irreparable, such that it would bring about a permanent loss of a kind qua kind. Second, that it is morally wrong to impose a risk for a reparable (but not compensable) harm that exceeds what realistically could be repaired. I set out here to do two things. First, I describe the moral problem to be addressed for any principle-guiding decisions about risk. A central claim in this article is that risk decisions are epistemically impaired decisions, and that we must, alongside outcome uncertainty, also take both epistemic uncertainty and moral uncertainty into account. Second, I introduce the idea of reparability as a moral constraint in the form of two versions of the Reparability Principle. Such a principle, I argue, could have some interesting advantages that seem both morally intuitive and that come with some advantages against some of the epistemic challenges posed by risk impositions. (shrink)

Biomedical researchers are trained to use positivistic approaches to develop efficacious treatments and pursue cures for illness and disease. Accordingly, they may rarely engage persons living with the disease in the development of research questions and protocols (Sacristán et al., 2015). Just as patient narratives can create therapeutic partnerships in delivery of treatment (DasGupta & Charon, 2004), they offer value to the research process to emphasize the person with the disease, rather than the disease, in isolation. In this chapter, we (...) are interested in the role of patient stories as tools for influencing the biomedical research process (Greenhalgh, 2009; Panofsky, 2011). Applying Ellingson’s (2009) approach to crystallization, we explore intersections in the literature on patient advocacy, our own narratives, and those from biomedical researchers and patients. We seek to uncover the value and implications of involving not only patients but also patients’ stories (Hyden, 1997) in creating an agenda for research in healthcare. (shrink)

Health care systems can positively influence our personal decision-making and health-related behavior only if we trust them. I propose a conceptual analysis of the trust relation between the public and a healthcare system, drawing from healthcare studies and philosophical proposals. In my account, the trust relation is based on an epistemic component, epistemic authority, and on a value component, the benevolence of the healthcare system. I argue that it is also modified by the vulnerability of the public on healthcare matters, (...) and by the system’s credibility. I apply my proposed analysis of public trust in health care systems to the phenomenon of vaccine hesitancy, a tendency to question vaccine policies, and to seek alternative vaccine schedules or to refuse vaccination. Understanding the role of trust and its components can be key to understanding the phenomenon. (shrink)