We would like to thank the authors of the excellent Open Peer Commentaries on our target article, “Implementing Expanded Prenatal Genetic Testing: Should Parents Have Access to Any and All Fetal Ge...

The application of machine learning in health care holds great promise for improving care. Indeed, our own team is collaborating with experts in machine learning and statistical modeling to bu...

We read with interest Lanphier and Anani’s manuscript on trauma-informed ethics consultation. Their model rightly integrates trauma-informed principles within the ethics c...

The healthcare ethics consultant holds a widely described role in the modern American hospital. S/he may practice within a clinical discipline and be trained in bioethics, or be a trained phi...

Last year the Office of the Director of National Intelligence released its report on the unprecedented amassing of biodata by the People’s Republic of China, the profit to be had through accumulati...

Trauma-informed care in pediatrics is an organizing principle for health care delivery that is based on the science of toxic stress and the insights of attachment theory. In their groundbreak...

McCradden et al.’s article makes a distinctive contribution to the growing literature on the ethics of artificial intelligence in medicine. Not only do the authors raise important ethical is...

Complex clinical ethics cases require a blend of compassion, sensitivity, and tenacity in order to navigate the hard work required of stakeholders. Each person comes to the table with rich historie...

Bioethics has received important criticisms for its perceived privileging of biomedical authority with longstanding calls for greater recognition of the social, political, economic, historical, and...

Elizabeth Lanphier and Uchenna E. Anani provide a powerful argument for the value of a trauma-informed approach to the ethics consultation, which acknowledges the perspectives of all stakeho...

The research ethics framework put forward by McCradden et al. to support systematic inquiry in the development of artificial intelligence and machine learning technologies in healt...

McCradden and colleagues' argues that machine learning in health care poses new challenges to appropriate evaluation for safe use in clinical care. It also claims that “the longstanding syst...

McCradden et al. propose to close the “AI chasm” between algorithms and clinically meaningful application using the norms of evidence-based medicine and clinical research, with the rat...

The application of artificial intelligence and machine learning technologies in healthcare have immense potential to improve the care of patients. While there are some emerging practices surro...

When Jennifer Blumenthal-Barby was a bioethics intern at the Cleveland Clinic while she was still a graduate student, she was puzzled by the decision making of some patients at the clinic. For exam...

Having a premature or critically ill infant in a neonatal intensive care unit is a traumatic experience for parents that can alter their lives. Parents navigate complex emotions of fear, unc...

The ethical review of research using methods of artificial intelligence and machine learning in health care contexts has become an important challenge for Research Ethics Boards (also refer...

The ethics of artificial intelligence and machine learning exemplify the conceptual struggle between applying familiar pathways of ethical analysis versus generating novel strategies. Mel...

In their article “A Research Ethics Framework for the Clinical Translation of Healthcare Machine Learning,” McCradden et al. highlight the various gaps that emerge when artificial intelligen...

Machine learning heralds highly transformative approaches to the automation of numerous clinical tasks, from diagnosis to risk assessment, and from prognosis to informing treatment decisions....

Fetal medicine is an emerging field that raises unique ethical concerns. Our children’s hospital started a Fetal Health Center 10 years ago. In this specialized setting, a multidisciplinary t...

As a practicing clinical ethicist at a major teaching hospital, I found it reassuring to learn that ethics consultation activity has increased overall. However, it was disheartening to see tha...

In this issue, Ellen Fox and colleagues report on their national study on ethics consultation in U.S. hospitals, following up on the previous 1999–2000 landmark study. Th...

Ellen Fox and collaborators have produced the most detailed description of healthcare ethics practices in the United States available. Some findings are shocking for anyone committed to promoting q...

There were several worrisome results in the long-awaited studies on clinical ethics consultation by Fox et al, but one of the most sobering was the self-assessments made by ECSs (Ethics Consult Ser...

With an overall estimated 5-year survival rate of 67 percent, bone marrow transplant is a potential cure for patients with primary immune regulatory diseases. Given that Sa...

Effective evaluation of any activity requires, first, that we understand what its objectives are, and second, that we can define and measure these objectives. For instance, a publicly listed compan...

In this case, an adolescent with a life-threatening immune disease experiences increased social complexity, child welfare involvement, and placement into foster care, which could disrupt a medical...

In their national follow-up study on ethics consultation in the U.S., Fox et al. report the worrying finding of a decline in efforts to evaluate ECs. Compared to the findings of Fox et...

With the growth and evolution of the field of clinical ethics, the one constant has been its variation. Resolving ethical issues at the bedside is done differently across the country based on one’s...

In the three target articles, Ellen Fox et al. present data from their seminal study on ethics consultation in US general hospitals (Fox, Danis, et al. 2022, Fox and Duke 2022, Fox, Tarzian, et al....

Shocking. There seems no other response to the Fox findings. The bioethics community has been working for decades to improve the quality of, and access to, competent healthcare ethics consultation....

Fox, Danis, Tarzian, and Duke have made a substantial contribution to the field of bioethics through the project described in this issue’s target articles (Fox, Tarzian, et al. 2022; Fox, Danis, et...

Much of what we know and see of ethics support, in literature and during trainings, workshops and conferences, derives from clinical ethicists working at academic medical centers. Besides the probl...

While the phenomenon of ‘moral distress’ has been of interest to the nursing community since Jameton first described it in 1984, moral distress is now understood to effect healthcare professionals...

In target articles for this special issue, Fox et al. report that ethics consultation practices have not improved significantly since 2000, and question whether the status quo affords patients...

In their target article, Fox & Duke provide evidence that consult volumes vary based on ethics staffing, leading to their conclusion that ethics consultation is an example of supply-sensitiv...

This case raises a number of complex ethical, legal, and practical issues, some of which cannot be resolved by a research ethics consultation. Sam is an adolescent who has end stage manifestations...

Whatever else these articles demonstrate, they reveal that two efforts closely associated with professionalizing healthcare ethics consultants —surveying the practice and certificating its pra...

In “Ethics Consultation in U.S. Hospitals: Opinions of Ethics Practitioners,” Fox and colleagues note that despite efforts of the American Society for Bioethics and Humanities to impr...

Fox’s update of her pivotal 2007 study on ethics consultations in U.S. hospitals found that the gap in ethics consultations is widening between large teaching hospitals and small community hospital...

The case presents a teenage girl, Sam*, in the end stages of a rare disease, with no proven therapeutic options and an investigational hematopoietic stem cell transplant has been offered thr...

For many rare diseases, the availability of effective interventions is limited or non-existent. In this context, clinical research evaluating emerging interventions may be the only potentially “the...

As members of the fetal surgery advisory board at a large tertiary care center, we read with great interest Hendriks’ et al. target article proposing a new ethical framework for fetal therap...

February is Black History Month and so healthcare practitioners will soon rummage history books for information about famous African Americans, like Onesimus, the African slave who...

Advancements in fetal assessment and therapeutic intervention in medical practice and clinical research call for corresponding progress in regulatory and ethical guidance. In “A new ethical framewo...

Assessing the risk-benefit ratio has always been considered key in designing clinical trials. These benefits can be diverse and may include social value and psychological benefits. When it comes to...

The target article by Camisha Russell continues the important discussion about race, racism and bioethics that has appeared in AJOB for the past few years. Russell critically examines how un...

Furthermore, adults with decision-making capacity, including pregnant women, can currently accept interventions with moderate net risks for themselves in other settings (e.g., open f...

New fetal therapies offer important prospects for improving health. However, having to consider both the fetus and the pregnant woman makes the risk–benefit analysis of fetal therapy trials challenging. Regulatory guidance is limited, and proposed ethical frameworks are overly restrictive or permissive. We propose a new ethical framework for fetal therapy research. First, we argue that considering only biomedical benefits fails to capture all relevant interests. Thus, we endorse expanding the considered benefits to include evidence-based psychosocial effects of fetal therapies. (...) Second, we reject the commonly proposed categorical risk and/or benefit thresholds for assessing fetal therapy research. Instead, we propose that the individual risks for the pregnant woman and the fetus should be justified by the benefits for them and the study’s social value. Studies that meet this overall proportionality criterion but have mildly unfavorable risk–benefit ratios for pregnant women and/or fetuses may be acceptable. (shrink)

Camisha Russell has written a beautiful essay articulating why race and racism should be centered within bioethics. I agree with her assertion that Black Lives Matter (and the subsequent backlash t...

In assessing the ethics of fetal therapy trials, we agree with Hendriks et al. that we should not just consider biomedical benefits, but also psychosocial benefits. Specifically, we argue th...

At no time in recent decades has more attention been paid to ethical issues in pregnancy. Particularly riveting—and alarming, to many—was the passage of Senate Bill 8, a Texas law banning abortion...

Interventions performed on a pregnant woman's body can affect the fetus in multiple ways. Such effects can be harmful to beneficial to the fetus. Unfortunately, the effects of new drugs and compoun...

Much has changed in maternal-fetal medicine since the early 2000s, when the previous ethical frameworks for fetal therapy trials were established. We applaud Hendriks and colleagues for taking on t...

Russell articulates compelling reasons that bioethicists and health care professionals should take individual responsibility for deconstructing structural injustices in healthcare through in...

The Black Lives Matter movement marks a critical moment in the ebb and flow of racial progress. But as Camisha Russell points out, this moment might not last long. Prior high-water marks in...

The history of maternal-fetal therapy is a complex and compelling one. It can be argued that the science and ethics underpinning this field evolved together, with emerging technology spurring on th...

In her evocative article “Meeting the Moment: Bioethics in the Time of Black Lives Matter,” Camisha Russell comprehensively illustrates why racism should be considered an important bioethica...

Russell’s “Meeting the Moment: Bioethics in the Time of Black Lives Matter” expertly identifies how race and racism are matters of bioethical concern that ought to be addressed via an indivi...

Camisha Russell argues that this contemporary moment of societal reckoning with the value of Black lives is also a moment for considering racism as a bioethical issue. She continues that bioethicis...

In “Meeting the Moment: Bioethics in the Time of Black Lives Matter,” Camisha Russell calls for transforming “bioethics-as-usual” with help from “outsiders”. Prior scholars agree...

As face shields are dusted off and conferences go virtual again, Omicron reminds us how the once-novel coronavirus ruptured our collective idea of medical training. For nearly 2 years, social media...

We were interested to read the current target article, given our admiration for the senior author’s comprehensive coverage of these same topics a decade ago (Donley, Hul...

In his carefully documented article, “From reciprocity to autonomy in physician-assisted death: an ethical analysis of the Dutch Supreme Court ruling in the Albert Heringa case,” Berand Florijn (20...

Prenatal genetic testing is becoming available for an increasingly broad set of diseases, and it is only a matter of time before parents can choose to test for hundreds, if not thousands, of genetic conditions in their fetuses. Should access to certain kinds of fetal genetic information be limited, and if so, on what basis? We evaluate a range of considerations including reproductive autonomy, parental rights, disability rights, and the rights and interests of the fetus as a potential future child. (...) We conclude that parents should be able to access information that could be useful during pregnancy, but that testing for non-medical information should be limited. Next, we argue that the government lacks a compelling state interest in regulating prenatal genetic testing and propose that regulation should occur through medical professional organizations. Finally, we present a framework for determining what testing physicians should recommend, offer neutrally, or not offer at all. (shrink)

As noninvasive prenatal testing is being implemented as a first-trimester prenatal screening modality in healthcare systems around the world, it raises ethical concerns. In theory, NIPT allo...

What is the future of genetic testing during pregnancy likely to look like? Given that the patterns of use of genetic testing in neonatology tend to precede, and thus predict, patterns of prenatal...

In 2002, the Dutch Euthanasia Act was put in place to regulate the ending of one’s life, permitting a physician to provide assistance in dying to a patient whose suffering the physician assesses as...

Prospective parents have long been interested in knowing as much information about their children as early as possible. This interest is not—and never has been—strictly limited to significant “medi...

Florijn’s helpful discussion of the Heringa case illustrates the difficulties in drawing a boundary on eligibility conditions for EAS. In Heringa, the Dutch Supreme Court reaffirmed...

The two target articles in this issue bring into focus the struggle for governance over biomedical interventions that may offer some families more agency—the capacity to act—in the context of many...

In "Implementing Expanded Prenatal Genetic Testing: Should Parents Have Access to Any and All Fetal Genetic Information?," Bayefsky and Berkman argue in favor of establishing three categorie...

In their article “Implementing Expanded Prenatal Genetic Testing: Should Parents Have Access to Any and All Fetal Genetic Information?” Bayefsky and Berkman briefly mention that: “[s]ome are...

In “Developing a Reflexive, Anticipatory, and Deliberative Approach to Unanticipated Discoveries: Ethical Lessons from iBlastoids,” we proposed a RAD approach to meet the challenging issues...

In their analysis of how much fetal genetic information prospective parents should be able to access, Bayefsky and Berkman determine that parents should only be able to access information th...

Bayefsky and Berkman argue in favor of evidence-based policy development for expanded prenatal genetic testing. They propose to identify what kinds of information pregnant persons, their par...

The target article describes a Dutch case that happened in 2008, where Albert Heringa helped his 98-year-old mother, whose general practitioner rejected her request for an assisted d...

The framework presented by Bayefsky and Berkman is based on having clear and accurate genetic information to offer parents, for them to either decide to prepare for birth or to terminate the...

In the Netherlands, the legalization of assisted suicide for persons with a death wish without severe illness, often referred to as persons with “completed life” or “tiredness of life,” is intensel...

Florijn’s analysis of the Dutch Supreme Court ruling on the Albert Heringa case demonstrates that the Dutch approach to justifying physician-assisted death is based primarily on the physician...

In their comprehensive article, Bayefsky and Berkman outline a framework for limiting access to certain types of fetal genetic information through professional self-regulation. Given the rap...

Florijn analyzes the ruling of the Court of Appeal in the Heringa case, focusing on the role of patient autonomy in physician assisted death (Florijn 2022). His analysis of the case shows that in Dutch euthanasia law patient autonomy as self-determination is limited by the reciprocal physician-patient relationship. Yet, it also gives an unbalanced view of the Dutch euthanasia regulation and its ethical foundation. By focusing on patient autonomy, the importance of unbearable and irremediable suffering as a prerequisite for euthanasia (...) becomes less visible. The requirement of irremediable suffering means that only a physician is allowed to perform euthanasia, since medical expertise is needed to establish whether there are still treatment options to alleviate suffering. We will discuss the importance of suffering, and its consequences for the “tired of life” debate. (shrink)