In their article, Friesen et al. (2023) discuss two challenging roles the IRBs are playing: protecting research participants from research-related risks and promoting inclusion of diverse populatio...

Among the terms that has become a stock phrase in articles about ECMO, whether academic or news stories, is “bridge to nowhere” (Abrams et.al. 2014; Bailey 2019). It is used to describe the tragic...

Childress and colleagues conclude that arguments from distributive justice do not justify discontinuing ECMO over a capacitated patient’s objections (Childress et al. 2023). However, this conclusio...

We are grateful to Friesen and colleagues for drawing attention to the tension between the protection of populations that may experience vulnerability with their inclusion in research (Friesen et a...

Some patients who are dependent on extracorporeal membrane oxygenation (ECMO) are alert and retain capacity to participate in decision-making, including decisions regarding whether to continue life...

Childress and colleagues (2023) review several arguments that would support the unilateral withdrawal of ECMO (extracorporeal membrane oxygenation) against the wishes of a capacitated patient (Mr....

Friesen et al. (2023) describe barriers to research in patient populations that have been historically labeled as vulnerable and, as a result, are under-represented in research due to the Instituti...

Childress et al. (2023) have provided a cogent overview of the ethical considerations involved in withdrawing extracorporeal membrane oxygenation (ECMO) over a capacitated patient’s objection. Alth...

Pregnant people are often listed among groups that have been excluded from research on the basis of perceived vulnerability, to the detriment of the entire class. Lack of research among pregnant pe...

Childress and coauthors present a case considering ECMO withdrawal over the objection of the conscious patient who is no longer a candidate for transplantation or other definitive therapeutic inter...

Childress et al. (2023) present the case of a patient with capacity who requests to stay on extracorporeal membrane oxygenation (ECMO) indefinitely and highlight the ethical challenges associated w...

Given the primary mandate for institutional review boards (IRBs) to protect potential participants from harm, the egregious history of research abuses, and the fact that there is no mention of incl...

Childress et al. (2023) argue in favor of “ECMO-DT,” the provision of ECMO indefinitely as “destination therapy” in the ICU for patients who are dependent on the technology to sustain their lives....

Childress et al. (2023) describe a disagreement between the competent patient and the physician recommending withdrawal of life-sustaining therapy (WLST). While the scenario is specific to ECMO, th...

Friesen et al. (2023) article explores tensions within institutional review boards (IRBs) when they aim both to protect participants from harm and to include under-represented populations in clinic...

I fundamentally agree with Childress et al. (2023) in the scenario they have constructed with Mr. J. None of the arguments they critically assess are ethically persuasive enough to justify removing...

The ethics of long-term Extracorporeal Membrane Oxygenation (ECMO) use, especially when organ recovery appears highly unlikely and the patient does not qualify for organ transplantation, are compli...

I agree fully that a “clearer picture of how vulnerability might manifest and how it can be accommodated, ideally without resorting to mere exclusion from research, is needed” (Friesen et al. 2023,...

In their target article, Friesen et al. (2023) offer recommendations primarily aimed at IRBs for reaching a better balance in the ongoing challenge of the protection-inclusion dilemma. The authors...

In the pediatric heart-failure population, severity of illness often forces therapeutic decisions to be made under time-pressure, such that mechanical circulatory support (MCS) can be offered as a...

In their analysis Childress et al. (2023) suggest that withdrawal of extracorporeal membrane oxygenation (ECMO) over a patient’s dissent is not justified by existing ethical arguments. The alternat...

Extracorporeal membrane oxygenation (ECMO) is currently reserved predominantly for bridging patients to a different destination therapy, but the use of ECMO as a destination therapy itself (ECMO-DT...

Childress et al. (2023) critically examine claims used to support unilateral withdrawal of life-sustaining ECMO over the objections of capacitated patients. The authors raise important concerns abo...

Unfortunately, there is broad confusion regarding the justification for healthcare professionals unilaterally limiting or withdrawing life-prolonging interventions. Many mistakenly believe that suc...

In their target article, Childress et al. (2023) contemplate the ethical considerations associated with determining if and when life-sustaining interventions (in this case, ECMO) can be unilaterall...

There is a well-known American legal maxim, hard cases make bad law. If we agree that Mr. J’s case is hard, what lessons follow from the application of current ECMO guidelines and what kind of supp...

IRBs often face dueling values in research: their historically grounded mission to protect research participants from harm conflicts with more recent attention to the importance of including underr...

In articulating the protection-inclusion dilemma, Friesen et al. (2023) identify an important issue facing institutional review boards (IRBs) and elucidate historical factors contributing to its de...

Life-saving healthcare technology evolves over time, raising new ethical questions. What was once experimental becomes standard care, and what was once unthinkable becomes the next frontier. Ethici...

Adolescence, defined in the US as 11–21 years of age, is a critical period for prevention, as it marks the onset of risk behaviors. Minor (<18 years) self-consent and inclusion in biomedical resear...

In “IRBs and The Protection Inclusion Dilemma: Finding a Balance,” Friesen et al. (2023) argue that IRBs ought to attend more, and better, to the need for the inclusion of under-researched populati...

In this issue of American Journal of Bioethics, Childress et al. address one of the most challenging modern clinical ethical dilemmas: the awake, competent patient dependent on extracorporeal membr...

First, the authors should be congratulated for bringing our attention to this important issue. They have made important observations about what may be holding us back in efforts to make progress in...

In “IRBs and the Protection-Inclusion Dilemma: Finding a Balance,” Dr. Phoebe Friesen and her collaborators (2023) provide a compelling framework that helps Institutional Review Boards (IRBs) think...

The COVID-19 pandemic’s disproportionate harm to racialized communities and increased public attention to the deaths of Black people at the hands of police (Elijah McClain, Breonna Taylor, George F...

ECMO is a short-term measure providing temporary life support until resolution of the primary insult or transplantation. Thanks to technological advances in life support, its use has increased enor...

In their target article, Childress et al provide a detailed analysis of dilemmas arising from disagreement between an ICU team and a competent patient (Mr J) about dis/continuation of extra-corpore...

Sedlakova and Trachsel (2023) discuss the ethical concerns associated with employing what they term conversational artificial intelligence as therapist substitutes. Given their apprehensions, they...

Psychotherapy is provided by professionals, trained, supervised and certified by other professionals, all the way back to Freud and similar founding fathers. Even though methods and styles vary, pa...

In their scoping review of the literature on artificial womb technology (AWT), De Bie et al. report that “complete ectogenesis has been hailed as an alternative to abortion,” (De Bie et al. 2023, 7...

The paper by De Bie et al. (2023) provides an overview of various ethical arguments related to artificial womb technology (AWT). We believe some important feminist concerns about this technology ne...

Successful deployment of “artificial womb technology (AWT)” is anticipated within a decade or so. In the case of “partial” ectogestation, in vivo gestation precedes fetal transfer to an artificial...

Recent discussion on artificial womb technology (AWT) has given rise to a proliferation of terms to denote the subject of AWT. De Bie et al. opt for “fetal neonate” or “fetonate’ as “the best way t...

In their article, Sedlakova and Trachsel (2023) propose a holistic, ethical, and epistemic analysis of conversational artificial intelligence (CAI) in psychotherapeutic settings. They mainly descri...

We applaud Sedlakova and Trachsel’s work and their description of conversational artificial intelligence (CAI) as possessing a hybrid nature with features of both a tool and an agent (Sedlakova and...

In their paper, “Conversational Artificial Intelligence in Psychotherapy: A New Therapeutic Tool or Agent?” Sedlakova and Trachsel (2023) claim that therapeutic insights and therapeutic changes are...

De Bie et al. (2023) introduces a framework to conceptualize ethical issues based on four different domains, but the problem lies in the domains being falsely bounded. Apart from the step from doma...

De Bie et al. (2023) call attention at the conclusion of their essay to the “novel questions” generated by complete ectogenesis. The question I explore is how complete ectogenesis from conception t...

De Bie et al. (2023) found that most feminist literature praises Artificial Womb Technologies (AWT) for its potential to increase equality among the sexes. This literature frames gestation as a poi...

In their article, De Bie et al. (2023) provide a scoping review of the ethical and socio-legal issues arising from research into, and the potential, maybe even likely deployment of, artificial womb...

Sedlakova and Traschel (2023) propose limiting the scope and capabilities of psychotherapy-delivering conversational artificial intelligence (CAI), as (1) they deceive some users into thinking they...

In their thought-provoking article, Sedlakova and Trachsel (2023) defend the view that the status—both epistemic and ethical—of Conversational Artificial Intelligence (CAI) used in psychotherapy is complicated. While therapeutic CAI seems to be more than a mere tool implementing particular therapeutic techniques, it falls short of being a “digital therapist.” One of the main arguments supporting the latter claim is that even though “the interaction with CAI happens in the course of conversation… the conversation is profoundly different from a conversation with (...) a human therapist” (Sedlakova and Trachsel 2023, 8). In particular, unlike a human therapist, CAI cannot help its users gain new insight and self-understanding (Sedlakova and Trachsel 2023). We agree that currently available therapeutic CAI cannot be considered a “digital therapist,” however, we think that the issue surrounding the acquisition of new self-understanding in the interaction with therapeutic CAI is more complicated than Sedlakova and Trachsel suggest. (shrink)

De Bie et al. argued that the decision “to transfer the fetus to AWT falls under maternal autonomy” while “once the fetonate is being supported by AWT, decision making would become a shared parenta...

In their careful analysis of conversational artificial intelligence (CAI) in psychotherapy, Sedlakova and Trachsel (2023) propose a framework for the ethical evaluation of such technologies that lo...

As strong as the ethical overview of artificial womb technology (AWT) by De Bie and colleagues is (De Bie et al. 2023), it does not adequately address ethical considerations that may arise within C...

With the public release of the large language model-driven ChatGPT in November 2022, the potential for Conversational Artificial Intelligence (CAI) has once again catapulted into the spotlight. CAI...

Sedlakova and Trachsel (hereafter referred to as “the authors”) argue that conversational artificial intelligence (CAI) in psychotherapy presents an ethical challenge as a tool with aspects of agen...

De Bie et al. (2023) hold out their paper as an effort “to identify the broad range of ethical concerns and considerations regarding AWT” and to organize them “into a comprehensive framework to org...

De Bie et al. provide a novel framework for assessing ethical considerations in artificial womb technology (AWT) based on four phases of human prenatal development (DeBie 2023). As the authors note...

Sedlakova and Trachsel (2023) identify a major benefit of conversational artificial intelligence (CAI) in psychotherapy as its ability to expand access to mental healthcare for vulnerable populatio...

The review by De Bie et al. (2023) provides an overview of the current ethical literature on artificial womb technology (AWT). Two characteristics stand out, and provide the basis for our commentar...

According to Russell and Norvig’s (2009) classification, Artificial Intelligence (AI) is the field that aims at building systems which either think rationally, act rationally, think like humans, or...

Five years ago, remarkable animal experiments on artificial womb technology (AWT) at Children’s Hospital of Philadelphia (CHOP) got us thinking about the ethical for premature babies. We recognized...

De Bie et al. (2023) provide a thorough review of the existing literature concerning Artificial Womb Technology (AWT) using the PRISMA-ScR method. The summary of the scoping review they conducted a...

Sedlakova and Trachsel (2023) advocate for a holistic approach to assessing ethical application of conversational artificial intelligence (CAI) in mental health therapy. They first describe CAI as...

Sedlakova and Trachsel (2023) argue that on the one hand, conversational artificial intelligence (CAI) does not fulfill the necessary conditions for full attribution of agency, such as having consc...

In 2017, Partridge et al. published remarkable experimental results concerning the use of a new artificial womb technology (AWT) with lambs, developed at Children’s Hospital of Philadelphia, called...

Sedlakova and Trachsel (2023) consider conversational artificial intelligence (CAI) as a new way of providing psychotherapy to patients. This is an important topic, and Sedlakova and Trachsel have...

In their article, “Non-invasive prenatal testing for ‘non-medical’ traits: ensuring consistency in ethical decision-making,” Hilary Bowman-Smart and colleagues (2023) claim merely to lay out the gr...

De Bie et al. (2023) provide a helpful framework for understanding many of the ethical considerations regarding artificial womb technology (AWT), particularly in relation to existing reproductive t...

De Bie et al. posit thatthe best way to describe the person who would receive current AWT is as a “fetal neonate” or fetonate. Neonatal pertains to the fact that the subject is removed from the wom...

Good listening is an essential element in the provision of quality healthcare (Attree 2001). Good listening also supports accurate diagnosis, patient adherence to medical recommendations, and stron...

In their comprehensive review article, De Bie et al., using some references, discreetly point out that pregnant women’s decision in Domain III to undergo fetal extraction via C-section should conti...

It is an understatement to say we live in an exciting time considering the increasingly widespread applications of artificial intelligence (AI). This observation is brought to the fore by Sedlakova...

Sedlakova and Traschel argue that conversational artificial intelligence (CAI) is more than a mere tool, but not quite an agent, as it “simulates having a therapeutic conversation [but] does not re...

The introduction of chatGPT illustrates the rapid developments within Conversational Artificial Intelligence (CAI) technologies (Gordijn and Have 2023). Ethical reflection and analysis of CAI are c...

De Bie et al. (2023) propose an organizing framework for different stages of human gestational development from conception to the viable premature. They also identify ethical considerations and con...

When used in psychotherapy, Sedlakova and Trachsel (2023) hypothesize that conversational artificial intelligence (CAI) ought to be considered as a new and hybrid artifact somewhere on a spectrum b...

I thank Jane Sedlakova and Manuel Trachsel for their work on situating conversational artificial intelligence’s (CAI) potential role in psychotherapy. In their article, Sedlakova and Trachsel argue...

What happens when a patient-interfacing conversational artificial intelligence system (CAI)—AI that combines natural language understanding, processing, and machine-learning models to autonomously...

Kolbe and de Melo-Martin (2023) describe fatal problems in current definitions and measurement of moral distress and injury (MD/I) in medical professionals, which impede development of genuine atte...

Shen-yi Liao and Vanessa Cabonell’s “Materialized Oppression in Medical Tools and Technologies,” joins the long list of groundbreaking papers whose importance is obscured by an innocuous title. Som...

Biomedical practice can encode and perpetuate oppressive ideologies. This encoding and perpetuation, scholars like Liao and Carbonell (2023) convincingly argue, can occur not only via social practi...

In “Moral Distress: What are we measuring?” Kolbe and de Melo-Martin (2023) rightly note that varied understanding of moral distress, paired with shortcomings in existing empirical tools to accurat...

Our team at the Centre for Clinical Ethics has long been engaged in internal discussion about the purpose and value of ethics debriefs and their purported role in reducing moral distress (Morley an...

Liao and Carbonell discuss the role of (supposed) racial differences and racism in two medical devices: pulse oximeters and spirometers. They show that what might seem like cases of mere bias, are...

ChatGPT is an artificial intelligence (AI) chatbot that processes and generates natural language text, offering human-like responses to a wide range of questions and prompts. Five days after its re...

Kolbe and de Melo-Martin’s (2023) arguments draw attention to what is most useful about moral distress—identifying its causes is at least as important as measuring its severity. Jameton’s original...

Liao and Carbonell’s (2023) article, “Materialized Oppression in Medical Tools and Technologies” directs our attention, not to new cutting edge medical technologies, but to the pulse oximeter and t...

Liao and Carbonell argue that medical devices are often not merely biased, but rather materialize oppression through the perpetuation of oppression into the present and future (Liao and Carbonell 2...

Liao and Carbonell point out that much of the danger embedded in “materialized oppression” derives from the fact that the essence of that marginalized oppression may not be overt. It can often rece...

Medical devices with built-in bias can both result from, and contribute to, harmful systemic racial oppression—a point that Liao and Carbonell (2023) argue convincingly in the target article of thi...

Kolbe and de Melo-Martin (2023) raise important concerns about the limited usefulness of measures of moral distress. They propose that moral distress is best measured in terms of “illegitimate inst...

Liao and Carbonell explore how oppressive medical technologies constitute materiality insofar as they reflect past oppression, embody oppression in the present day, and carry oppression into the fu...

Kolbe and de Melo-Martin (2023) provide a much needed reflection on the methods by which we measure moral distress. Their analysis, however, gives off the impression that the measures of moral dist...

It is well-known that racism is encoded into the social practices and institutions of medicine. Less well-known is that racism is encoded into the material artifacts of medicine. We argue that many medical devices are not merely biased, but materialize oppression. An oppressive device exhibits a harmful bias that reflects and perpetuates unjust power relations. Using pulse oximeters and spirometers as case studies, we show how medical devices can materialize oppression along various axes of social difference, including race, gender, class, (...) and ability. Our account uses political philosophy and cognitive science to give a theoretical basis for understanding materialized oppression, explaining how artifacts encode and carry oppressive ideas from the past to the present and future. Oppressive medical devices present a moral aggregation problem. To remedy this problem, we suggest redundantly layered solutions that are coordinated to disrupt reciprocal causal connections between the attitudes, practices, and artifacts of oppressive systems. (shrink)

Whilst Kolbe and de Melo-Martin (2023) appropriately identify a range of concerns about the validity of existing instruments to measure moral distress, one additional limitation that the authors di...

Often a physician’s first introduction to a patient is not a physical encounter but a review of their chart. A glaring “violence risk” flag in an Electronic Medical Record (EMR) is often noticeable...

While Jameton’s (1984) definition of moral distress has been embraced by researchers and scholars for recognizing the many constraints that nurses experience on their moral agency, it has also been...

All research tools have limitations. Not all tools will be suited to every purpose. Understanding the limitations and accurately interpreting the output from any tool is essential to conducting mea...

In the target article by Kolbe and de Melo-Martin (2023), the authors discussed several shortcomings of major instruments of moral distress, including the Moral Distress Scale (MDS) (Corley et al....

Moral distress is indeed distressing for those who experience it and whose sense of integrity can be shaken by exposure to events or situations that test their core values and ethical belief system...

Laura Kolbe and Inmaculada de Melo-Martin (2023) give perspective on the challenge of measuring and defining the concept of moral distress (MD). Limitations in psychometric instruments are a consta...

The article “Moral distress: What are we measuring?” by Kolbe and de Melo-Martin (2023) is an important contribution both to the literature and research agenda for the complicated construct of mora...

Bowman-Smart et al. (2023) argue for a framework to examine the ethical issues associated with genetic screening for non-medical traits in the context of noninvasive prenatal testing (NIPT). Such s...

The paper by Bowman-Smart et al. (2023) on noninvasive prenatal genetic testing (NIPT) for non-medical traits aims to set out the case for and the case against such testing. In response to their pa...

The Target Article “Non-invasive prenatal testing for ‘non-medical’ traits: ensuring consistency in ethical decision making” by Bowman-Smart et al. (2023) raises the important issue that “decision-...

In the piece, “Ethical Issues in Using Behavior Contracts to Manage the ‘Difficult’ Patient and Family,” Chase Yuan and I (Fiester and Yuan 2023) argue that an important set of ethical concerns nee...

If polygenic risk scores for traits are to be provided to parents before—as opposed to after—a child is born, these scores will provide the very first units of information upon which parents will b...

In their recently published target article, Bowman-Smart et al. (2023) summarize the ethical issues at play in both the case for and the case against using NIPT to screen for non-medical traits.The...

The article by Bowman-Smart et al. (2023) argues that there are inconsistencies in our ethical frameworks regarding the use of noninvasive prenatal testing (NIPT) and polygenic scores for identifyi...

In “Non-invasive prenatal testing for ‘non-medical’ traits: Ensuring consistency in ethical decision-making,” Bowman-Smart et al. (2023) lay out arguments both for and against the potential use of...

Bowman-Smart et al. (2023) suggest that the current ethical frameworks used to evaluate the use of noninvasive prenatal technologies (e.g., NIPT) are inconsistent when used to analyze the ethics of...

The authors of the target article discuss the expansion of the scope of noninvasive prenatal testing (NIPT) that is likely to occur in the near future, including its possible extension to “non-medi...

It is unarguable that the implementation and use of noninvasive prenatal testing (NIPT) should be critical and appropriate. After all, decisions that influence when and how to have children have ut...

Due to the recent gains in biomedical sciences, the fetus1 is more exposed and subjected to increasing possibilities of intervention, becoming a full-fledged patient, and entering more often into a...

Bowman-Smart et al. (2023) have written a thoughtful and balanced essay examining some of the ethical issues surrounding large scale use of noninvasive prenatal testing (NIPT) (Fan et al. 2008; Chi...

Hilary Bowman-Smart et al. (2023) have rightly pointed out that one of the recurring criticisms of the use of noninvasive prenatal testing (NIPT) for nonmedical trait prediction is the probabilistic nature of polygenic scores. Those estimates do not establish a direct causal relationship, but rather a probabilistic association between having some genetic variants and the development of particular traits. The authors then suggest that differences in the predictive value of polygenic scores may pose a practical problem that increases the information (...) overload of the reproductive decisions after NIPT. In this commentary, we offer a reframing of this issue in three steps. First, drawing on various empirical articles from the genomic medicine literature, we indicate how the appraisal of uncertainty may entail a different psychological cost between individuals when considering genetic information. Second, we analyze the specific limitation of having probabilistic information on non-medical traits with genetic contribution and compare the burden placed on reproductive decisions by the use of polygenic scores in gestational periods after NIPT with the case of embryo selection. Third, following the authors’ claim that “understanding causality is important,” we briefly address the problem of causation in the debate on polygenic scores. (shrink)

Hilary Bowman-Smart et al. (2023) have rightly pointed out that one of the recurring criticisms of the use of noninvasive prenatal testing (NIPT) for non-medical trait prediction is the probabilist...

Bowman-Smart and colleagues (2023) argue that techniques to screen and analyze the fetal genome are rapidly evolving, and are sometimes already offered commercially. These new developments will all...

Bowman-Smart et al. (2023) do an admirable job of explaining the expansion of noninvasive prenatal testing and outlining the arguments for and against testing for “non-medical” traits—arguments com...

Bowman-Smart et al. (2023) outlined the scenario that with the content expansion of noninvasive prenatal testing (NIPT) in the future, its application is not limited to the screening for aneuploidi...

Bowman-Smart et al. (2023) sketched a hypothetical scenario involving noninvasive prenatal testing (NIPT) for “non-medical” traits available for expectant parents in the near future. By critically...

Over the past quarter century, organ donation after the circulatory determination of death (DCD) has grown in acceptance and prevalence throughout the world (Domínguez-Gil et al. 2021). Notwithstan...

Nobel Laureate Kazou Ishiguro’s (2010) novel “Never Let Me Go” follows individuals intentionally bred to donate their organs over multiple years, ultimately dying when the final “vital organs” are...

In their target article, Nielsen Busch and Mjaaland (2023) address a longstanding debate within the bioethics and organ transplantation community regarding whether controlled donation after circula...

The interpretation of the dead donor rule (DDR) has been central to recent debates regarding normothermic regional perfusion with controlled donation after circulatory death (NRP-cDCD). Proponents...

The “Dead Donor Rule” (DDR) is an important injunction shaping the field of organ retrieval and scholarly assessments of specific retrieval practices’ permissibility (e.g., Pasquerella, Smith, and...

In their intriguing and closely argued paper Nielsen Busch and Mjaaland argue that the “Dead Donor Rule” (DDR) has been consistently misinterpreted and that it should properly be understood as a ru...

As usually understood, the Dead Donor Rule (DDR) for organ donation requires either that (1) the donor is already dead (which legally occurs when death is determined by neurological criteria), and/or that (2) organ procurement does not cause the donor’s death.

Nielsen Busch and Mjaaland (2023) argue that controlled donation after circulatory death does not violate the dead donor rule because the dead donor rule “merely requires that procurement of organs...

Nielsen Busch and Mjaaland (2023) raise important considerations, but confuse certain critical issues and overlook others, and questions emerge about how these decisions should be made in our socie...

In their target article, Nielsen Busch and Mjaaland (2023) exhort us to stop “focus[ing] on the validity of the criteria for determination of [circulatory] death” and “instead [look at] DCD protoco...

We agree with Nielsen Busch and Mjaaland’s (2023) assessment that the Dead Donor Rule (DDR) should be viewed as an essential requirement of the organ donation process, and that the essence of the r...

Nielsen Busch and Mjaaland argue that controlled donation after circulatory death (DCD), and normothermic regional perfusion (NRP) do not violate the dead donor rule (DDR) (Nielsen Busch and Mjaala...

In their target article, Nielsen Busch and Mjaaland seek to shift focus away from controversy over whether donors in protocols of controlled donation after circulatory death (cDCD) are dead. Citing...

In their article, Nielsen Busch and Mjaaland defend the moral permissibility of cDCD, suggesting that much of the controversy around this donation practice has been the result of a misinterpretatio...

People of a certain age will immediately recognize the image of a distraught woman, hand to her forehead, bemoaning how she just now realized that she forgot to have children. Nielsen Busch and Mja...

A 55-year-old man, admitted to the hospital after an episode of aphasia due to transient ischemic attack, underwent ultrasound imaging that showed near occlusion of the left carotid artery. A carot...

Nielsen Busch and Mjaaland (2023) argue that controlled donation after cardiac death (cDCD) protocols prescribe the extraction of organs that do not violate the dead donor rule. I argue here that e...

Nielsen Bush and Mjaaland (“the authors” hereafter) argue that controlled donation after circulatory death (cDCD) protocols that target abdominal organs are consistent with the dead donor rule (DDR...

In “Does Controlled Donation after Circulatory Death Violate the Dead Donor Rule?” the authors maintain that compliance with the dead donor rule (DDR) does not require a valid determination of deat...

Emil Nielsen Busch and Marius Mjaaland (2023) ask whether controlled donation after circulatory death (cDCD) violates the dead donor rule (DDR). They begin their article with the claim, “The dead d...

The Dead Donor Rule (DDR) states that organ donation must not cause the death of the donor and is generally interpreted as requiring that the donor be declared dead before organs can be removed (Be...

We thank Nielsen Busch and Mjaaland for their article on the dead donor rule (Nielsen Busch and Mjaaland 2023). We would like to take this opportunity to go beyond the dead donor rule in order to r...

In their manuscript, Nielsen Busch and Mjaaland (2023) argue that controlled donation after circulatory death (cDCD) is compatible with the dead donor rule (DDR) by describing the DDR and the incor...

This case raises questions of what “trauma-informed care” (TIC) means to the medical team caring for Maurice and how they embrace a TIC approach. There are established principles of trauma-informed...

The field of bioethics is calling for a new generation of scholars equipped with the normative, empirical, and practical knowledge and expertise to prioritize equity concerns largely underrepresent...

Nelson et al.(2023) argue that the inclusion of personal experience in bioethical debates has significant benefits and liabilities, illustrating their claim with two examples: unproven medical treatments and disability bioethics. We believe that the benefits of including personal experience in disability bioethics far exceed its liabilities. The absence of participants with relevant experience impoverishes and biases bioethical debates, while the biases risked by their inclusion are hardly unique to personal experiences and are readily mitigated.

In their article, “Ethical Issues in Using Behavior Contracts to Manage the “Difficult’ Patient and Family,” Autumn Fiester and Chase Yuan (2023) identify six ethical concerns regarding the specifi...

Maddie’s story illustrates the critical importance of healthcare teams (HCTs) having inclusive multidisciplinary provider meetings prior to siloed conversations with families. It is paramount that...

In popular culture, death is typically presented as clear and binary- someone is either walking and talking and alive, or very obviously still and dead. Reality is more complicated than the movies,...

Layers of complexity arise when a person arrives in an Intensive Care Unit (ICU) due to self-harm intended to end their life and when there is known past personal trauma. We highlight three importa...

Fiester and Yuan (2023) highlight ethical concerns important for considering behavioral contracts to manage charged/challenging interactions with patients and/or families. We support the viability...

In their article, Nelson et al. (2023) raise concerns regarding the “paradox of experience” as it relates to the practice of bioethics. They argue that while experience provides individuals with in...

This excellent article (Nelson et al. 2023) clarifies the difficulties of incorporating diverse voices and those who speak of their own experience, into bioethics, a field that aspires to be object...

In their intriguing article “Bioethics and the Moral Authority of Experience,” Nelson and colleagues (2023) provide important insight into an important ethical problem. We frequently demand that th...

While we agree with Fiester and Yuan (2023) that ethicists should not execute behavioral agreements in their role as clinical consultants along with many of the authors’ criticisms of such contract...

Nelson et al. (2023) have deftly articulated a “paradox of experience” that applies to most if not all stakeholder engagement efforts in bioethics. Eliciting the perspectives of people with first-h...

In many ways, Maddie’s case brings together some of the most challenging features seen in clinical ethics consultation. First, it centers around a heart-wrenching event—the near-drowning of a young...

Staff at Cincinnati Children’s Hospital Medical Center used behavior contracts to address “difficult” patients and families for years. Nonadherence with recommended medical treatments was generally...

Nelson et al. (2023) make a unique contribution, raising key questions and considerations about the value of lived experiences as they pertain to normative debates in bioethics. The authors grapple...

In “Bioethics and the Moral Authority of Experience,” Ryan Nelson et al. (2022) argue that personal experience can simultaneously be an asset and a liability in the practice of bioethics and medici...

Fiester and Yuan (2023) address an important, hitherto underdiscussed issue: ethical hazards of behavior contracts linked to patients’ and families’ demeanor in interacting with the healthcare team...

Fiester and Yuan discuss important ethical concerns regarding the use of behavior contracts in addressing conflict with patients and families labeled as “difficult” (Fiester and Yuan 2023). We agre...

Fiester and Yuan offer several critiques of the use of behavior contracts in managing difficult patients and families (Fiester and Yuan 2023). This open peer commentary is not intended to refute ea...

In their paper, “Ethical Issues in Using Behavior Contracts to Manage the “Difficult” Patient and Family,” Autumn Fiester and Chase Yuan raise numerous important ethical concerns regarding behavior...

Workplace violence in healthcare has become a crisis in and of itself. Before COVID, more than three-quarters of all US workplace violence injuries were against healthcare professionals with some s...

Trauma informed care (TIC) “realizes the widespread impact of trauma… recognizes the signs and symptoms of trauma in clients, families and staff; responds by fully integrating knowledge of trauma i...

In “Bioethics and the Moral Authority of Experience,” Nelson et al. explore what they refer to as “The Paradox of Experience.” The authors characterize this paradox formally as follows:(A) Personal...

Responding to the impact of prior trauma on mental and physical health and disease/injury recovery is decades-old. In the 1970s, healthcare providers and researchers expanded our understanding of h...

The target article (Nelson et al. 2023) offers a valuable contribution to the “paradox of experience,” which was illustrated by using examples about access to unproven medical products and disabili...

Navigating tragic circumstances in pediatrics requires consideration of parental grief responses. We meet parents where they are, not where we might want them to be. Different parents grieve differ...