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  1. Content Analysis of Requests for Religious Exemptions From a Mandatory Influenza Vaccination Program for Healthcare Personnel.Armand H. Antommaria & Cynthia A. Prows - 2018 - Journal of Medical Ethics 44 (6):389-391.
    Objective Having failed to achieve adequate influenza vaccination rates among employees through voluntary programmes, healthcare organisations have adopted mandatory ones. Some programmes permit religious exemptions, but little is known about who requests religious objections or why. Methods Content analysis of applications for religious exemptions from influenza vaccination at a free-standing children’s hospital in Cincinnati, Ohio, USA during the 2014–2015 influenza season. Results Twelve of 15 260 employees submitted applications requesting religious exemptions. Requestors included both clinical and non-clinical employees. All requestors (...)
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  2.  46
    Consent and the Ethical Duty to Participate in Health Data Research.Angela Ballantyne & G. Owen Schaefer - 2018 - Journal of Medical Ethics 44 (6):392-396.
    The predominant view is that a study using health data is observational research and should require individual consent unless it can be shown that gaining consent is impractical. But recent arguments have been made that citizens have an ethical obligation to share their health information for research purposes. In our view, this obligation is sufficient ground to expand the circumstances where secondary use research with identifiable health information is permitted without explicit subject consent. As such, for some studies the Institutional (...)
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  3. Ethics Briefing.Martin Davies, Ruth Campbell, Sophie Brannan, Veronica English, Rebecca Mussell & Julian C. Sheather - 2018 - Journal of Medical Ethics 44 (6):429-430.
    In April, the UK House of Commons Science and Technology committee published a report evaluating the readiness of the National Health Service to incorporate genomic testing into mainstream service provision.1 The committee also examined some of the research and regulatory considerations in relation to the ongoing development of genome editing. ### Genomics in the NHS The main focus of the report is the 100,000 Genomes Project and the various practical and ethical challenges associated with the planned roll-out of the Genomics (...)
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  4. Towards a National Genomics Medicine Service: The Challenges Facing Clinical-Research Hybrid Practices and the Case of the 100 000 Genomes Project. [REVIEW]Sandi Dheensa, Gabrielle Samuel, Anneke M. Lucassen & Bobbie Farsides - 2018 - Journal of Medical Ethics 44 (6):397-403.
    Clinical practice and research are governed by distinct rules and regulations and have different approaches to, for example, consent and providing results. However, genomics is an example of where research and clinical practice have become codependent. The 100 000 genomes project is a hybrid venture where a person can obtain a clinical investigation only if he or she agrees to also participate in ongoing research—including research by industry and commercial companies. In this paper, which draws on 20 interviews with professional (...)
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  5.  1
    Research or Clinical Care: What’s the Difference?Nina Hallowell - 2018 - Journal of Medical Ethics 44 (6):359-360.
    In 1979 the National Commission for the Protection of Human Subjects of Biomedical and Behavioural Research in the US delivered a set of guidelines for the ethical conduct of research on human research subjects.1 In developing these guidelines, subsequently known as The Belmont Report, the Commission was “...directed to consider: the boundaries between biomedical and behavioural research and the accepted and routine practice of medicine”; and outline a set of ethical principles which would specifically govern research activities. The Report notes (...)
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  6.  1
    From Whom Do Physicians Obtain Consent for Surgery?Zahra Jarayedi & Fariba Asghari - 2018 - Journal of Medical Ethics 44 (6):366-370.
    Objective To evaluate the knowledge and performance of surgical residents regarding the person from whom informed consent should be taken for surgery and from whom the consent is taken in practice. Materials and methods This study was done in 2013. The population of this study was all residents of urology, surgery, orthopaedic surgery and gynaecology of Tehran and Iran University of Medical Sciences. The study tool was a self-administered questionnaire, containing questions on their knowledge and performance regarding informed consent acquisition (...)
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  7.  1
    Face Transplantation for the Blind: More Than Being Blind in a Sighted World.Joseph Lee - 2018 - Journal of Medical Ethics 44 (6):361-365.
    Face transplantation is a landmark in reconstructive surgery involving vascularised composite allotransplantation. A recent issue of FT for patients who are blind has arisen. Some bioethicists recommend not excluding a patient who is blind, as this may amount to discrimination. From an ethical standpoint, FT for those with blindness is appropriate in selected candidates. This article seeks to add to the clinical evidence supporting FT for those with blindness by detailing a complementary psychosocial perspective. Currently, there is little relevant research (...)
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  8.  2
    Learning Health Systems, Clinical Equipoise and the Ethics of Response Adaptive Randomisation.Alex John London - 2018 - Journal of Medical Ethics 44 (6):409-415.
    To give substance to the rhetoric of ‘learning health systems’, a variety of novel trial designs are being explored to more seamlessly integrate research with medical practice, reduce study duration and reduce the number of participants allocated to ineffective interventions. Many of these designs rely on response adaptive randomisation. However, critics charge that RAR is unethical on the grounds that it violates the principle of equipoise. In this paper, I reconstruct critiques of RAR as holding that it is inconsistent with (...)
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  9.  1
    Researching About Us Without Us: Exploring Research Participation and the Politics of Disability Rights in the Context of the Mental Capacity Act 2005.Gillian Loomes - 2018 - Journal of Medical Ethics 44 (6):424-427.
    The right to active participation by disabled people in academic research has been discussed at length in recent years, along with the potential for such research to function as a tool in challenging oppression and pursuing disability rights. Significant ethical, legal and methodological dilemmas arise, however, in circumstances where a disabled person loses the capacity to provide informed consent to such participation. In this article, I consider disability politics and academic research in the context of the Mental Capacity Act 2005, (...)
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  10.  2
    Resuscitation Decisions at the End of Life: Medical Views and the Juridification of Practice.Fiona M. A. MacCormick, Charlotte Emmett, Paul Paes & Julian C. Hughes - 2018 - Journal of Medical Ethics 44 (6):376-383.
    Background Concerns about decision making related to resuscitation have led to two important challenges in the courts resulting in new legal precedents for decision-making practice. Systematic research investigating the experiences of doctors involved in decisions about resuscitation in light of the recent changes in law remains lacking. Aim To analyse the practice of resuscitation decision making on hospital wards from the perspectives of doctors. Design The data presented in this paper were collected as part of a wider research study of (...)
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  11.  3
    Artificial Gametes, the Unnatural and the Artefactual.Anna Smajdor, Daniela Cutas & Tuija Takala - 2018 - Journal of Medical Ethics 44 (6):404-408.
    In debates on the ethics of artificial gametes, concepts of naturalness have been used in a number of different ways. Some have argued that the unnaturalness of artificial gametes means that it is unacceptable to use them in fertility treatments. Others have suggested that artificial gametes are no less natural than many other tissues or processes in common medical use. We suggest that establishing the naturalness or unnaturalness of artificial gametes is unlikely to provide easy answers as to the acceptability (...)
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  12.  1
    Montgomery, Informed Consent and Causation of Harm: Lessons From Australia or a Uniquely English Approach to Patient Autonomy?Malcolm K. Smith & Tracey Carver - 2018 - Journal of Medical Ethics 44 (6):384-388.
    The UK Supreme Court in Montgomery v Lanarkshire Health Board adopts an approach to information disclosure in connection with clinical treatment that moves away from medical paternalism towards a more patient-centred approach. In doing so, it reinforces the protection afforded to informed consent and autonomous patient decision making under the law of negligence. However, some commentators have expressed a concern that the widening of the healthcare providers’ duty of disclosure may provide impetus, in future cases, for courts to adopt a (...)
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  13.  3
    Legitimacy in Bioethics: Challenging the Orthodoxy.William R. Smith - 2018 - Journal of Medical Ethics 44 (6):416-423.
    Several prominent writers including Norman Daniels, James Sabin, Amy Gutmann, Dennis Thompson and Leonard Fleck advance a view of legitimacy according to which, roughly, policies are legitimate if and only if they result from democratic deliberation, which employs only public reasons that are publicised to stakeholders. Yet, the process described by this view contrasts with the actual processes involved in creating the Affordable Care Act and in attempting to pass the Health Securities Act. Since the ACA seems to be legitimate, (...)
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  14.  2
    Chronic Disease as Risk Multiplier for Disadvantage.Francisca Stutzin Donoso - 2018 - Journal of Medical Ethics 44 (6):371-375.
    This paper starts by establishing a prima facie case that disadvantaged groups or individuals are more likely to get a chronic disease and are in a disadvantaged position to adhere to chronic treatment despite access through Universal Health Coverage. However, the main aim of this paper is to explore the normative implications of this claim by examining two different but intertwined argumentative lines that might contribute to a better understanding of the ethical challenges faced by chronic disease health policy. The (...)
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  15.  3
    Deemed Consent: Assessing the New Opt-Out Approach to Organ Procurement in Wales.Andreas Albertsen - 2018 - Journal of Medical Ethics 44 (5):314-318.
    In December 2015, Wales became the first country in the UK to move away from an opt-in system in organ procurement. The new legislation introduces the concept of deemed consent whereby a person who neither opt in nor opt out is deemed to have consented to donation. The data released by the National Health Service in July 2017 provide an excellent opportunity to assess this legislation in light of concerns that it would decrease procurement rates for living and deceased donation, (...)
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  16.  2
    Against Proportional Shortfall as a Priority-Setting Principle.Samuel Altmann - 2018 - Journal of Medical Ethics 44 (5):305-309.
    As the demand for healthcare rises, so does the need for priority setting in healthcare. In this paper, I consider a prominent priority-setting principle: proportional shortfall. My purpose is to argue that proportional shortfall, as a principle, should not be adopted. My key criticism is that proportional shortfall fails to consider past health. Proportional shortfall is justified as it supposedly balances concern for prospective health while still accounting for lifetime health, even though past health is deemed irrelevant. Accounting for this (...)
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  17.  8
    The Ethical Justification for the Use of Non-Human Primates in Research: The Weatherall Report Revisited.Gardar Arnason - 2018 - Journal of Medical Ethics 44 (5):328-331.
    The Weatherall report on the use of non-human primates in research was published in 2006. Its main conclusion was that there is a strong scientific case for the use of non-human primates in some cases, but the report stressed the importance of evaluating each case in the light of the availability of alternatives. In addition to arguing for the scientific necessity of using non-human primates in research, the report also provided an ethical justification. As could be expected, the report was (...)
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  18.  8
    Objections Still Fail: A Response to Faria.Gardar Arnason - 2018 - Journal of Medical Ethics 44 (5):334-335.
    In her reply to my critical assessment of objections to the Weatherall report’s justification of non-human primate research, Catia Faria focuses on three objections which she entitles ‘the disanalogy’, ‘the utilitarian calculus’ and ‘species overlap’. Faria finds my assessment unconvincing, butI argue that the objections still fail.
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  19.  2
    ‘He Who Helps the Guilty, Shares the Crime’? INGOs, Moral Narcissism and Complicity in Wrongdoing.Pete Buth, Benoit de Gryse, Sean Healy, Vincent Hoedt, Tara Newell, Giovanni Pintaldi, Hernan del Valle, Julian C. Sheather & Sidney Wong - 2018 - Journal of Medical Ethics 44 (5):299-304.
    Humanitarian organisations often work alongside those responsible for serious wrongdoing. In these circumstances, accusations of moral complicity are sometimes levelled at decision makers. These accusations can carry a strong if unfocused moral charge and are frequently the source of significant moral unease. In this paper, we explore the meaning and usefulness of complicity and its relation to moral accountability. We also examine the impact of concerns about complicity on the motivation of humanitarian staff and the risk that complicity may lead (...)
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  20.  2
    A Flimsy Case for the Use of Non-Human Primates in Research: A Reply to Arnason.Catia Faria - 2018 - Journal of Medical Ethics 44 (5):332-333.
    The Weatherall Report claims that research on non-human primates is permitted and morally required. The argument rests on the following thought experiment: > The hospital fire : A hospital is on fire. Some of the residents are humans and others are non-human animals. You can only save one group. What do you do? Some people have the intuition that we should rescue the humans. According to the report, if we accept that human lives have priority over non-human lives in this (...)
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  21.  3
    Institute of Medical Ethics Guidelines for Confirmation of Appointment, Promotion and Recognition of UK Bioethics and Medical Ethics Researchers.Lucy Frith, Carwyn Hooper, Silvia Camporesi, Thomas Douglas, Anna Smajdor, Emma Nottingham, Zoe Fritz, Merryn Ekberg & Richard Huxtable - 2018 - Journal of Medical Ethics 44 (5):289-291.
    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 (...)
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  22.  3
    Ethics, Health Policy, and Zika: From Emergency to Global Epidemic?Euzebiusz Jamrozik & Michael J. Selgelid - 2018 - Journal of Medical Ethics 44 (5):343-348.
    Zika virus was recognised in 2016 as an important vector-borne cause of congenital malformations and Guillain-Barré syndrome, during a major epidemic in Latin America, centred in Northeastern Brazil. The WHO and Pan American Health Organisation, with partner agencies, initiated a coordinated global response including public health intervention and urgent scientific research, as well as ethical analysis as a vital element of policy design. In this paper, we summarise the major ethical issues raised during the Zika epidemic, highlighting the PAHO ethics (...)
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  23.  1
    Choice, Pressure and Markets in Kidneys.Julian Koplin - 2018 - Journal of Medical Ethics 44 (5):310-313.
    We do not always benefit from the expansion of our choice sets. This is because some options change the context in which we must make decisions in ways that render us worse off than we would have been otherwise. One promising argument against paid living kidney donation holds that having the option of selling a ‘spare’ kidney would impact people facing financial pressures in precisely this way. I defend this argument from two related criticisms: first, that having the option to (...)
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  24.  3
    Ethical Issues When Modelling Brain Disorders Innon-Human Primates.Carolyn P. Neuhaus - 2018 - Journal of Medical Ethics 44 (5):323-327.
    Non-human animal models of human diseases advance our knowledge of the genetic underpinnings of disease and lead to the development of novel therapies for humans. While mice are the most common model organisms, their usefulness is limited. Larger animals may provide more accurate and valuable disease models, but it has, until recently, been challenging to create large animal disease models. Genome editors, such as Clustered Randomised Interspersed Palindromic Repeat, meet some of these challenges and bring routine genome engineering of larger (...)
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  25.  3
    Public Mental Health Crisis Management and Section 136 of the Mental Health Act.Aileen O’Brien, Faisil Sethi, Mark Smith & Annie Bartlett - 2018 - Journal of Medical Ethics 44 (5):349-353.
    The interface between mental health services and the criminal justice system presents challenges both for professionals and patients. Both systems are stressed and inherently complex. Section 136 of the Mental Health Act is unusual being both an aspect of the Mental Health Act and a power of arrest. It has a long and controversial history related to concerns about who has been detained and how the section was applied. More recently, Section 136 has had a public profile stemming from the (...)
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  26.  2
    Implementing Post-Trial Access Plans for HIV Prevention Research.Amy Paul, Maria W. Merritt & Jeremy Sugarman - 2018 - Journal of Medical Ethics 44 (5):354-358.
    Ethics guidance increasingly recognises that researchers and sponsors have obligations to consider provisions for post-trial access to interventions that are found to be beneficial in research. Yet, there is little information regarding whether and how such plans can actually be implemented. Understanding practical experiences of developing and implementing these plans is critical to both optimising their implementation and informing conceptual work related to PTA. This viewpoint is informed by experiences with developing and implementing PTA plans for six large-scale multicentre HIV (...)
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  27.  2
    Dutch Practice of Euthanasia and Assisted Suicide: A Glimpse at the Edges of the Practice.Timothy Quill - 2018 - Journal of Medical Ethics 44 (5):297-298.
    Euthanasia and assisted suicide was openly permitted but not technically legal in the Netherlands for decades. In 2002, it was formally legalised through the Termination of Life on Request and Assisted Suicide Review Procedures Act, subject to two main criteria: the patient had to be capable of making voluntary decisions and the patient had to experience unbearable suffering without prospect of improvement. Within the Netherlands, EAS has wide acceptance, and the public in general seems to favour a liberal interpretation of (...)
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  28.  4
    Moral Narcissism and Moral Complicity in Global Health and Humanitarian Aid.Mark Sheehan - 2018 - Journal of Medical Ethics 44 (5):287-288.
    Some of the best instances of bioethics are applications of ethical conceptual analysis to real-world cases that is done in a way that prompts both reflection on the part of the practitioners involved in the real-world case and reflection by the bioethicist on the way in which the field of bioethics understands the concept in question. Buth et al ’s paper in this issue is a fine example of just this. Their paper brings together three important concepts that straddle the (...)
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  29.  3
    Developments in the Practice of Physician-Assisted Dying: Perceptions of Physicians Who Had Experience with Complex Cases.Marianne C. Snijdewind, Donald G. van Tol, Bregje D. Onwuteaka-Philipsen & Dick L. Willems - 2018 - Journal of Medical Ethics 44 (5):292-296.
    Background Since the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide with their physicians and the way physicians experience the practice of EAS. Aim To show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS. Methods We conducted a secondary analysis of in-depth interviews with 28 Dutch (...)
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  30.  1
    Using Best Interests Meetings for People in a Prolonged Disorder of Consciousness to Improve Clinical and Ethical Management.Derick T. Wade - 2018 - Journal of Medical Ethics 44 (5):336-342.
    Current management of people with prolonged disorders of consciousness is failing patients, families and society. The causes include a general lack of concern, knowledge and expertise; a legal and professional framework which impedes timely and appropriate decision-making and/or enactment of the decision; and the exclusive focus on the patient, with no legitimate means to consider the broader consequences of healthcare decisions. This article argues that a clinical pathway based on the principles of the English Mental Capacity Act 2005 and using (...)
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  31.  2
    Dangers of Neglecting Non-Financial Conflicts of Interest in Health and Medicine.Miriam Wiersma, Ian Kerridge & Wendy Lipworth - 2018 - Journal of Medical Ethics 44 (5):319-322.
    Non-financial interests, and the conflicts of interest that may result from them, are frequently overlooked in biomedicine. This is partly due to the complex and varied nature of these interests, and the limited evidence available regarding their prevalence and impact on biomedical research and clinical practice. We suggest that there are no meaningful conceptual distinctions, and few practical differences, between financial and non-financial conflicts of interest, and accordingly, that both require careful consideration. Further, a better understanding of the complexities of (...)
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  32.  1
    Attitudes of Paediatric and Obstetric Specialists Towards Prenatal Surgery for Lethal and Non-Lethal Conditions.Ryan M. Antiel, Farr A. Curlin, John D. Lantos, Christopher A. Collura, Alan W. Flake, Mark P. Johnson, Natalie E. Rintoul, Stephen D. Brown & Chris Feudtner - 2018 - Journal of Medical Ethics 44 (4):234-238.
    Background While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians' attitudes about prenatal surgery for lethal and non-lethal conditions and to elucidate characteristics associated with these attitudes. Methods Survey of 1200 paediatric surgeons, neonatologists and maternal–fetal medicine specialists. Results Of 1176 eligible physicians, 670 responded. In the setting of a lethal condition for which prenatal surgery would likely result in the child (...)
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  33.  7
    A Challenge to Unqualified Medical Confidentiality.Alexander Bozzo - 2018 - Journal of Medical Ethics 44 (4):248-252.
    Medical personnel sometimes face a seeming conflict between a duty to respect patient confidentiality and a duty to warn or protect endangered third parties. The conventional answer to dilemmas of this sort is that, in certain circumstances, medical professionals have an obligation to breach confidentiality. Kenneth Kipnis has argued, however, that the conventional wisdom on the nature of medical confidentiality is mistaken. Kipnis argues that the obligation to respect patient confidentiality is unqualified or absolute, since unqualified policies can save more (...)
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  34.  5
    Between Professional Values, Social Regulations and Patient Preferences: Medical Doctors’ Perceptions of Ethical Dilemmas.Berit Bringedal, Karin Isaksson Rø, Morten Magelssen, Reidun Førde & Olaf Gjerløv Aasland - 2018 - Journal of Medical Ethics 44 (4):239-243.
    Background We present and discuss the results of a Norwegian survey of medical doctors' views on potential ethical dilemmas in professional practice. Methods The study was conducted in 2015 as a postal questionnaire to a representative sample of 1612 doctors, among which 1261 responded. We provided a list of 41 potential ethical dilemmas and asked whether each was considered a dilemma, and whether the doctor would perform the task, if in a position to do so. Conceptually, dilemmas arise because of (...)
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  35.  4
    Voluntary Sterilisation and Access to IVF in Québec.Katharine Browne - 2018 - Journal of Medical Ethics 44 (4):262-265.
    Bill 20, An Act to Enact the Act to promote access to family medicine and specialized medicine services and to amend various legislative provisions relating to assisted procreation, was introduced to reduce costs associated with Québec’s healthcare in general and in vitro fertilisation in particular. Passed in November 2015, the new law introduces a number of exclusion criteria for access to and funding for IVF treatment. Remarkably, one exclusion criterion—prior voluntary sterilisation—has prompted little critical commentary. The two justifications offered for (...)
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  36.  5
    Ethics of Treatment Interruption Trials in HIV Cure Research: Addressing the Conundrum of Risk/Benefit Assessment.Gail E. Henderson, Holly L. Peay, Eugene Kroon, Rosemary Jean Cadigan, Karen Meagher, Thidarat Jupimai, Adam Gilbertson, Jill Fisher, Nuchanart Q. Ormsby, Nitiya Chomchey, Nittaya Phanuphak, Jintanat Ananworanich & Stuart Rennie - 2018 - Journal of Medical Ethics 44 (4):270-276.
    Though antiretroviral therapy is the standard of care for people living with HIV, its treatment limitations, burdens, stigma and costs lead to continued interest in HIV cure research. Early-phase cure trials, particularly those that include analytic treatment interruption, involve uncertain and potentially high risk, with minimal chance of clinical benefit. Some question whether such trials should be offered, given the risk/benefit imbalance, and whether those who choose to participate are acting rationally. We address these questions through a longitudinal decision-making study (...)
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  37.  2
    What Can the Lived Experience of Participating in Risky HIV Cure-Related Studies Establish?Nir Eyal - 2018 - Journal of Medical Ethics 44 (4):277-278.
    This response to Gail Henderson et al argues that they were right that interviewees’ appraisals of cure study participation should inform protocol review decisions, but wrong to take these appraisals at face value.
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  38.  2
    How to Hold an Ethical Pox Party.Euzebiusz Jamrozik - 2018 - Journal of Medical Ethics 44 (4):257-261.
    Pox parties are a controversial alternative to vaccination for diseases such as chickenpox. Such parties involve parents infecting non-immune children by exposing them to a contagious child. If successful, infection will usually lead to immunity, thus preventing infection later in life, which, for several vaccine-preventable diseases, is more severe than childhood infection. Some may consider pox parties more morally objectionable than opting out of vaccination through non-medical exemptions. In this paper, I argue that this is not the case. Pox parties (...)
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  39.  19
    Disability, Sex Rights and the Scope of Sexual Exclusion.Alida Liberman - 2018 - Journal of Medical Ethics 44 (4):253-256.
    In response to three papers about sex and disability published in this journal, I offer a critique of existing arguments and a suggestion about how the debate should be reframed going forward. Jacob M. Appel argues that disabled individuals have a right to sex and should receive a special exemption to the general prohibition of prostitution. Ezio Di Nucci and Frej Klem Thomsen separately argue contra Appel that an appeal to sex rights cannot justify such an exemption. I argue that (...)
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  40.  3
    From Assistive to Enhancing Technology: Should the Treatment-Enhancement Distinction Apply to Future Assistive and Augmenting Technologies?Francesca Minerva & Alberto Giubilini - 2018 - Journal of Medical Ethics 44 (4):244-247.
    The treatment-enhancement distinction is often used to delineate acceptable and unacceptable medical interventions. It is likely that future assistive and augmenting technologies will also soon develop to a level that they might be considered to provide users, in particular those with disabilities, with abilities that go beyond natural human limits, and become in effect an enhancing technology. In this paper, we describe how this process might take place, and discuss the moral implications of such developments. We argue that such developments (...)
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  41.  5
    A Critical Review of Conscientious Objection and Decriminalisation of Abortion in Chile.Adela Montero & Raúl Villarroel - 2018 - Journal of Medical Ethics 44 (4):279-283.
    From 1989 through September 2017, Chile’s highly restrictive abortion laws exposed women to victimisation and needlessly threatened their health, freedom and even lives. However, after decades of unsuccessful attempts to decriminalise abortion, legislation regulating pregnancy termination on three grounds was recently enacted. In the aftermath, an aggressive conservative drive designed to turn conscientious objection into a pivotal new obstacle, mounted during the congressional debate, has led to extensive, complex arguments about the validity and legitimacy of conscientious objection. This article offers (...)
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  42.  3
    Life-Extending Enhancements and the Narrative Approach to Personal Identity.Andrea Sauchelli - 2018 - Journal of Medical Ethics 44 (4):219-225.
    Various debates on the desirability and rationality of life-extending enhancements have been pursued under the presupposition that a generic psychological theory of personal identity is correct. I here discuss how the narrative approach to personal identity can contribute to these debates. In particular, I argue that two versions of the narrative approach offer good reasons to reject an argument against the rationality of life-extending enhancements.
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  43.  32
    Adverse Consequences of Article 12 of the UN Convention on the Rights of Persons with Disabilities for Persons with Mental Disabilities and an Alternative Way Forward.Matthé Scholten & Jakov Gather - 2018 - Journal of Medical Ethics 44 (4).
    It is widely accepted among medical ethicists that competence is a necessary condition for informed consent. In this view, if a patient is incompetent to make a particular treatment decision, the decision must be based on an advance directive or made by a substitute decision-maker on behalf of the patient. We call this the competence model. According to a recent report of the United Nations (UN) High Commissioner for Human Rights, article 12 of the UN Convention on the Rights of (...)
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  44.  2
    Does the Doctrine of Double Effect Apply to the Prescription of Barbiturates? Syme Vs the Medical Board of Australia.Xavier Symons - 2018 - Journal of Medical Ethics 44 (4):266-269.
    The doctrine of double effect is a principle of crucial importance in law and medicine. In medicine, the principle is generally accepted to apply in cases where the treatment necessary to relieve pain and physical suffering runs the risk of hastening the patient’s death. More controversially, it has also been used as a justification for withdrawal of treatment from living individuals and physician-assisted suicide. In this paper, I will critique the findings of the controversial Victorian Civil and Administrative Tribunal hearing (...)
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  45.  4
    Vulnerability in the Clinic: Case Study of a Transcultural Consultation.Melissa Dominicé Dao - 2018 - Journal of Medical Ethics 44 (3):167-170.
    Discrimination and inequalities in healthcare can be experienced by many patients due to many characteristics ranging from the obviously visible to the more subtly noticeable, such as race and ethnicity, legal status, social class, linguistic fluency, health literacy, age, gender and weight. Discrimination can take a number of forms including overt racist statement, stereotyping or explicit and implicit attitudes and biases. This paper presents the case study of a complex transcultural clinical encounter between the mother of a young infant in (...)
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  46.  2
    Bringing Science and Advocacy Together to Address Health Needs of People Who Inject Drugs.Liza Dawson, Steffanie A. Strathdee, Alex John London, Kathryn E. Lancaster, Robert Klitzman, Irving Hoffman, Scott Rose & Jeremy Sugarman - 2018 - Journal of Medical Ethics 44 (3):165-166.
    In crafting our paper on addressing the ethical challenges in HIV prevention research with people who inject drugs,1 we had hoped to stimulate further discussion and deliberation about the topic. We are pleased that three commentaries on our paper have begun this process.2 3 4 The commentaries rightly bring up important issues relating to community engagement and problems in translating research into practice in the fraught environments in which PWID face multiple risks. These risks include acquisition of HIV as well (...)
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  47.  2
    Addressing Ethical Challenges in HIV Prevention Research with People Who Inject Drugs.Liza Dawson, Steffanie A. Strathdee, Alex John London, Kathryn E. Lancaster, Robert Klitzman, Irving Hoffman, Scott Rose & Jeremy Sugarman - 2018 - Journal of Medical Ethics 44 (3):149-158.
    Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...)
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  48.  6
    ‘Absolutely Not!’ Contextual Values and Equality of Voices in Mental Health.K. W. M. Fulford & David Crepaz-Keay - 2018 - Journal of Medical Ethics 44 (3):185-186.
    Marie Stenlund’s careful reading of values-based practice and her demonstration of its links with Martha Nussbaum’s Capabilities Framework are innovative theoretically and have potentially important implications for policy and practice in mental health. As she indicates the two approaches converge in a number of key respects. Notably, both recognise the diversity of individual human values. This diversity crucially underpins contemporary person-centred conceptions of recovery in mental health based on quality of life as defined by reference to the values of the (...)
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  49.  2
    Public Reason and the Limited Right to Conscientious Objection: A Response to Magelssen.Jake Greenblum - 2018 - Journal of Medical Ethics 44 (3):206-209.
    In a recent article for this journal, Morten Magelssen argues that the right to conscientious objection in healthcare is grounded in the moral integrity of healthcare professionals, a good for both professionals and society. In this paper, I argue that there is no right to conscientious objection in healthcare, at least as Magelssen conceives of it. Magelssen’s conception of the right to conscientious objection is too expansive in nature. Although I will assume that there is a right to conscientious objection, (...)
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  50.  4
    Communities Need to Be Equal Partners in Determining Whether Research is Acceptable.Bridget G. Haire & John M. Kaldor - 2018 - Journal of Medical Ethics 44 (3):159-160.
    In many countries around the world, people who inject drugs remain at high risk of HIV acquisition not because effective forms of prevention are unknown, nor because they find effective prevention undesirable, but because those in charge, mainly politicians but also bureaucrats, find evidence-based practice politically unacceptable. The evidence for preventive efficacy of harm reduction strategies, most prominently needle and syringe programmes but also treatment programmes such as opiate substitution, is irrefutable.1 However, political responses to drug use issues are varied (...)
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  51.  3
    The ‘French Exception’: The Right to Continuous Deep Sedation at the End of Life.Ruth Horn - 2018 - Journal of Medical Ethics 44 (3):204-205.
    In 2016, a law came into force in France granting terminally ill patients the right to continuous deep sedation until death. This right was proposed as an alternative to euthanasia and presented as the ‘French response’ to problems at the end of life. The law draws a distinction between CDS and euthanasia and other forms of sympton control at the end of life. France is the first country in the world to legislate on CDS. This short report describes the particular (...)
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  52.  2
    ‘Wicked Problems’, Community Engagement and the Need for an Implementation Science for Research Ethics.James V. Lavery - 2018 - Journal of Medical Ethics 44 (3):163-164.
    In 1973, Rittel and Webber coined the term ‘wicked problems’, which they viewed as pervasive in the context of social and policy planning.1 Wicked problems have 10 defining characteristics: they are not amenable to definitive formulation; it is not obvious when they have been solved; solutions are not true or false, but good or bad; there is no immediate, or ultimate, test of a solution; every implemented solution is consequential, it leaves traces that cannot be undone; there are no criteria (...)
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  53.  4
    Medical and Bioethical Considerations in Elective Cochlear Implant Array Removal.Maryanna S. Owoc, Elliott D. Kozin, Aaron Remenschneider, Maria J. Duarte, Ariel Edward Hight, Marjorie Clay, Susanna E. Meyer, Daniel J. Lee & Selena Briggs - 2018 - Journal of Medical Ethics 44 (3):174-179.
    Objective Cochlear explantation for purely elective reasons is not well studied. Herein, we aim to provide data and expert commentary about elective cochlear implant removal that may help to guide clinical decision-making and formulate guidelines related to CI explantation. Data sources We address these objectives via three approaches: case report of a patient who desired elective CI removal; review of literature and expert discussion by surgeon, audiologist, bioethicist, CI user and member of Deaf community. Review methods A systematic review using (...)
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  54.  5
    Do-Not-Attempt-Resuscitation Orders: Understanding and Interpretation of Their Use in the Hospitalised Patient in Ireland. A Brief Report.Helen O’Brien, Siobhan Scarlett, Anne Brady, Kieran Harkin, Rose Anne Kenny & Jeanne Moriarty - 2018 - Journal of Medical Ethics 44 (3):201-203.
    Following the introduction of do-not-resuscitate orders in the 1970s, there was widespread misinterpretation of the term among healthcare professionals. In this brief report, we present findings from a survey of healthcare professionals. Our aim was to examine current understanding of the term do-not-attempt-resuscitate, decision-making surrounding DNAR and awareness of current guidelines. The survey was distributed to doctors and nurses in a university teaching hospital and affiliated primary care physicians in Dublin via email and by hard copy at educational meetings from (...)
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  55.  1
    The Rise of Reimbursement-Based Medicine: The Case of Bone Metastasis Radiation Treatment.Marcos Santos, Jan Helge Solbakk & Volnei Garrafa - 2018 - Journal of Medical Ethics 44 (3):171-173.
    It has been hypothesised that the reimbursement system pertaining to radiotherapy is influencing prescription practices for patients with cancer with bone metastases. In this paper, we present and discuss the results of an empirical study that was undertaken on patient records, referred to radiotherapy for the treatment of bone metastases, in a medium-size city, in southern Brazil, during the period of March 2006 to March 2014. Our findings seem to confirm this hypothesis: after a change in the reimbursement method, radiation (...)
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  56.  1
    Wicked Problems, Complex Solutions, and the Cost of Trust.Julian Savulescu - 2018 - Journal of Medical Ethics 44 (3):147-148.
    Medicine interacts with the social, legal and political elements of life. For example, UK homelessness leads to a reduction in life-expectancy of around 30 years.1 This issue is a daily reality for practicising clinicians. In research and research ethics, vulnerable groups, including the socially vulnerable, are frequently excluded from research. While there are good reasons for this, it can mean exclusion from benefits as well as from risks. In our feature article this month, Dawson et al make a compelling and (...)
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  57.  10
    Is Consistency Overrated?S. Andrew Schroeder - 2018 - Journal of Medical Ethics 44 (3):199-200.
    In their insightful article, ‘The Disvalue of Death in the Global Burden of Disease’, Solberg et al argue that there is a potential incoherence in the way disability-adjusted life years are calculated. Morbidity is measured in years lived with disability in a way quite unlike the way mortality is measured in years of life lost. This potentially renders them incommensurable, like apples and oranges, and makes their aggregate—DALYs—conceptually unsound. The authors say that it is ‘vital’ to address this problem, that (...)
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  58.  5
    The Disvalue of Death in the Global Burden of Disease.Carl Tollef Solberg, Ole Frithjof Norheim & Mathias Barra - 2018 - Journal of Medical Ethics 44 (3):192-198.
    In the Global Burden of Disease study, disease burden is measured as disability-adjusted life years. The paramount assumption of the DALY is that it makes sense to aggregate years lived with disability and years of life lost. However, this is not smooth sailing. Whereas morbidity is something that happens to an individual, loss of life itself occurs when that individual’s life has ended. YLLs quantify something that involves no experience and does not take place among living individuals. This casts doubt (...)
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  59.  2
    Promoting the Freedom of Thought of Mental Health Service Users: Nussbaum’s Capabilities Approach Meets Values-Based Practice.Mari Stenlund - 2018 - Journal of Medical Ethics 44 (3):180-184.
    This article clarifies how the freedom of thought as a human right can be understood and promoted as a right of mental health service users, especially people with psychotic disorder, by using Martha Nussbaum’s capabilities approach and Fulford’s and Fulford et al ’s values-based practice. According to Nussbaum, freedom of thought seems to primarily protect the capability to think, believe and feel. This capability can be promoted in the context of mental health services by values-based practice. The article points out (...)
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  60.  1
    Sometimes, Not Always, Not Never: A Response to Pickard and Pearce.Patrick J. Sullivan - 2018 - Journal of Medical Ethics 44 (3):209-210.
    This paper provides a response to Hanna Pickard and Stephen Pearce’s paper ‘Balancing costs and benefits: a clinical perspective does not support a harm minimisation approach for self-injury outside of community settings.’ This paper responded to my article ‘Should healthcare professionals sometimes allow harm? The case of self-injury.’ There is much in the paper that I would agree with, but I feel it is important to respond to a number of the criticisms of my paper in order to clarify my (...)
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  61.  4
    Doubly Distributing Special Obligations: What Professional Practice Can Learn From Parenting.Jon Tilburt & Baruch Brody - 2018 - Journal of Medical Ethics 44 (3):212-216.
    A traditional ethic of medicine asserts that physicians have special obligations to individual patients with whom they have a clinical relationship. Contemporary trends in US healthcare financing like bundled payments seem to threaten traditional conceptions of special obligations of individual physicians to individual patients because their population-based focus sets a tone that seems to emphasise responsibilities for groups of patients by groups of physicians in an organisation. Prior to undertaking a cogent debate about the fate and normative weight of special (...)
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  62.  13
    Donor Blood Screening and Moral Responsibility: How Safe Should Blood Be?Marcel Verweij & Koen Kramer - 2018 - Journal of Medical Ethics 44 (3):187-191.
    Some screening tests for donor blood that are used by blood services to prevent transfusion-transmission of infectious diseases offer relatively few health benefits for the resources spent on them. Can good ethical arguments be provided for employing these tests nonetheless? This paper discusses—and ultimately rejects—three such arguments. According to the ‘rule of rescue’ argument, general standards for cost-effectiveness in healthcare may be ignored when rescuing identifiable individuals. The argument fails in this context, however, because we cannot identify beforehand who will (...)
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  63.  4
    Donor Blood Screening and Moral Responsibility: How Safe Should Blood Be?Marcel Verweij & Koen Kramer - 2018 - Journal of Medical Ethics 44 (3):187-191.
    Some screening tests for donor blood that are used by blood services to prevent transfusion-transmission of infectious diseases offer relatively few health benefits for the resources spent on them. Can good ethical arguments be provided for employing these tests nonetheless? This paper discusses—and ultimately rejects—three such arguments. According to the ‘rule of rescue’ argument, general standards for cost-effectiveness in healthcare may be ignored when rescuing identifiable individuals. The argument fails in this context, however, because we cannot identify beforehand who will (...)
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  64.  2
    Moving the Needle: Strengthening Ethical Protections for People Who Inject Drugs in Clinical Trials.Daniel Wolfe - 2018 - Journal of Medical Ethics 44 (3):161-162.
    Those researching HIV prevention measures for people who inject drugs face a dilemma. Regions where baseline HIV prevalence and onward transmission via injecting is sufficiently high to power HIV prevention trials are also those where repressive laws, policies and practices raise concerns about the ethics of research subject protection. Dawson et al, outlining criteria to address ethical challenges in HIV prevention research among PWID, recommend that all trial participants be offered sterile injecting equipment and urge additional strategies to limit research (...)
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  65.  1
    Comments on Durante’s Account of Multiculturalism.Tom L. Beauchamp - 2018 - Journal of Medical Ethics 44 (2):84-85.
    Chris Durante’s comments on my article about the compatibility of universal morality, particular moralities and multiculturalism indicate that we have very different approaches to and understandings of these three notions. Durante investigates multiculturalism from the perspective of political philosophy, whereas my approach is grounded in moral rather than political philosophy. Since he refers to his framework as an ‘ethico-political theory’, he may regard his account as a synthesis of moral and political philosophy, but this representation seems incorrect. He repeatedly refers (...)
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  66.  2
    Matters of Interest to Medical Professionals.Kenneth Boyd - 2018 - Journal of Medical Ethics 44 (2):75-76.
    What should readers expect of a journal, not primarily of ethics nor of bioethics, but of medical ethics? The ‘Disclaimer’ on this journal’s inside front cover states that it is ‘intended for medical professionals’. That perhaps narrows the field: but what interests ‘medical professionals’? Writing in 1796, the young Samuel Taylor Coleridge, poet, polymath and professional patient, declared that ‘Physicians… are shallow animals: having always employed their minds about Body and Gut, they imagine that in the whole system of things (...)
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  67.  4
    Ethics Briefing.Sophie Brannan, Ruth Campbell, Martin Davies, Veronica English, Rebecca Mussell & Julian C. Sheather - 2018 - Journal of Medical Ethics 44 (2):145-146.
    The British Medical Association has published a new report on health and human rights in immigration detention in the UK. Locked up, locked out outlines how aspects of current detention policies and practices are detrimental to the health of those detained and the challenges doctors face in providing healthcare in the immigration detention setting. It makes a number of recommendations aimed at addressing policy and practice which impact on health and well-being, including calling for an end to the routine use (...)
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  68.  4
    Bioethics and Multiculturalism: Nuancing the Discussion.Chris Durante - 2018 - Journal of Medical Ethics 44 (2):77-83.
    In his recent analysis of multiculturalism, Tom Beauchamp has argued that those who implement multicultural reasoning in their arguments against common morality theories, such as his own, have failed to understand that multiculturalism is neither a form of moral pluralism nor ethical relativism but is rather a universalistic moral theory in its own right. Beauchamp’s position is indeed on the right track in that multiculturalists do not consider themselves ethical relativists. Yet, Beauchamp tends to miss the mark when he argues (...)
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  69.  9
    Correction: Is Current Practice Around Late Termination of Pregnancy Eugenic and Discriminatory? Maternal Interests and Abortion.Bmj Publishing Group Ltd And Institute Of Medical Ethics - 2018 - Journal of Medical Ethics 44 (2):132-132.
    Savulescu J. Is current practice around late termination of pregnancy eugenic and discriminatory? Maternal interests and abortion. J Med Ethics 2001;27:165–71. Lachlan de Crespigny contributed in a major way to the conceptualisation, design, administration of surveys, ….
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  70.  4
    Correction: ‘Is This Knowledge Mine and Nobody Else's? I Don’T Feel That.’ Patient Views About Consent, Confidentiality and Information-Sharing in Genetic Medicine.Bmj Publishing Group Ltd And Institute Of Medical Ethics - 2018 - Journal of Medical Ethics 44 (2):137-137.
    Dheensa S, Fenwick A, Lucassen A.‘Is this knowledge mine ….
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  71.  4
    Correction: Going Above and Beneath the Call of Duty: The Luck Egalitarian Claims of Healthcare Heroes, and the Accomodation of Professionally-Motivated Treatment Refusal.Bmj Publishing Group Ltd And Institute Of Medical Ethics - 2018 - Journal of Medical Ethics 44 (2):142-142.
    Douglas T. Going above and beneath the call ….
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  72.  2
    Freedom of Conscience in Europe? An Analysis of Three Cases of Midwives with Conscientious Objection to Abortion.Valerie Fleming, Beate Ramsayer & Teja Škodič Zakšek - 2018 - Journal of Medical Ethics 44 (2):104-108.
    While abortion has been legal in most developed countries for many years, the topic remains controversial. A major area of controversy concerns women’s rights vis-a-vis the rights of health professionals to opt out of providing the service on conscience grounds. Although scholars from various disciplines have addressed this issue in the literature, there is a lack of empirical research on the topic. This paper provides a documentary analysis of three examples of conscientious objection on religious grounds to performing abortion-related care (...)
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  73.  4
    Against Lifetime QALY Prioritarianism.Anders Herlitz - 2018 - Journal of Medical Ethics 44 (2):109-113.
    Lifetime quality-adjusted life-year (QALY) prioritarianism has recently been defended as a reasonable specification of the prioritarian view that benefits to the worse off should be given priority in health-related priority setting. This paper argues against this view with reference to how it relies on implausible assumptions. By referring to lifetime QALY as the basis for judgments about who is worse off lifetime QALY prioritarianism relies on assumptions of strict additivity, atomism and intertemporal separability of sublifetime attributes. These assumptions entail that (...)
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  74.  7
    Perceptions of Control and Unrealistic Optimism in Early-Phase Cancer Trials.Lynn A. Jansen, Daruka Mahadevan, Paul S. Appelbaum, William M. P. Klein, Neil D. Weinstein, Motomi Mori, Catherine Degnin & Daniel P. Sulmasy - 2018 - Journal of Medical Ethics 44 (2):121-127.
    Purpose Recent research has found unrealistic optimism among patient-subjects in early-phase oncology trials. Our aim was to investigate the cognitive and motivational factors that evoke this bias in this context. We expected perceptions of control to be a strong correlate of unrealistic optimism. Methods A study of patient-subjects enrolled in early-phase oncology trials was conducted at two sites in the USA. Respondents completed questionnaires designed to assess unrealistic optimism and several risk attribute variables that have been found to evoke the (...)
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  75.  4
    Prolonged Immigration Detention, Complicity and Boycotts.Melanie Jansen, Alanna Sue Tin & David Isaacs - 2018 - Journal of Medical Ethics 44 (2):138-142.
    Australia’s punitive policy towards people seeking asylum deliberately causes severe psychological harm and meets recognised definitions of torture. Consequently, there is a tension between doctors’ obligation not to be complicit in torture and doctors’ obligation to provide best possible care to their patients, including those seeking asylum. In this paper, we explore the nature of complicity and discuss the arguments for and against a proposed call for doctors to boycott working in immigration detention. We conclude that a degree of complicity (...)
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  76.  2
    Ethical Behaviour of Physicians and Psychologists: Similarities and Differences.Michall Ferencz Kaddari, Meni Koslowsky & Michael A. Weingarten - 2018 - Journal of Medical Ethics 44 (2):97-100.
    Objective To compare the coping patterns of physicians and clinical psychologists when confronted with clinical ethical dilemmas and to explore consistency across different dilemmas. Population 88 clinical psychologists and 149 family physicians in Israel. Method Six dilemmas representing different ethical domains were selected from the literature. Vignettes were composed for each dilemma, and seven possible behavioural responses for each were proposed, scaled from most to least ethical. The vignettes were presented to both family physicians and clinical psychologists. Results Psychologists’ aggregated (...)
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  77.  23
    The Sensitivity Argument Against Child Euthanasia.Geoff Keeling - 2018 - Journal of Medical Ethics 44 (2):143-144.
    Is there a moral difference between euthanasia for terminally ill adults and euthanasia for terminally ill children? Luc Bovens considers five arguments to this effect, and argues that each is unsuccessful. In this paper, I argue that Bovens' dismissal of the sensitivity argument is unconvincing.
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  78.  2
    Informed Consent in Cluster Randomised Trials: New and Common Ethical Challenges.Sapfo Lignou - 2018 - Journal of Medical Ethics 44 (2):114-120.
    Cluster randomised trials are an increasingly important methodological tool in health research but they present challenges to the informed consent requirement. In the relatively limited literature on the ethics of cluster research there is not much clarity about the reasons for which seeking informed consent in cluster randomised trials may be morally challenging. In this paper, I distinguish between the cases where informed consent in cluster trials may be problematic due to the distinct features of ‘population-based’ interventions, which have not (...)
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  79.  2
    Penile Transplantation as an Appropriate Response to Botched Traditional Circumcisions in South Africa: An Argument Against.Keymanthri Moodley & Stuart Rennie - 2018 - Journal of Medical Ethics 44 (2):86-90.
    Traditional male circumcision is a deeply entrenched cultural practice in South Africa. In recent times, there have been increasing numbers of botched circumcisions by untrained and unscrupulous practitioners, leading to genital mutilation and often, the need for penile amputation. Hailed as a world’s first, a team of surgeons conducted the first successful penile transplant in Cape Town, South Africa in 2015. Despite the euphoria of this surgical victory, concerns about the use of this costly intervention in a context of severe (...)
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  80.  11
    Increasing Organ Donation Rates by Revealing Recipient Details to Families of Potential Donors.David Shaw & Dale Gardiner - 2018 - Journal of Medical Ethics 44 (2):101-103.
    Many families refuse to consent to donation from their deceased relatives or over-rule the consent given before death by the patient, but giving families more information about the potential recipients of organs could reduce refusal rates. In this paper, we analyse arguments for and against doing so, and conclude that this strategy should be attempted. While it would be impractical and possibly unethical to give details of actual potential recipients, generic, realistic information about the people who could benefit from organs (...)
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  81.  9
    What is the Ethics of Ageing?Christopher Simon Wareham - 2018 - Journal of Medical Ethics 44 (2):128-132.
    Applied ethics is home to numerous productive subfields such as procreative ethics, intergenerational ethics and environmental ethics. By contrast, there is far less ethical work on ageing, and there is no boundary work that attempts to set the scope for ‘ageing ethics’ or the ‘ethics of ageing’. Yet ageing is a fundamental aspect of life; arguably even more fundamental and ubiquitous than procreation. To remedy this situation, I examine conceptions of what the ethics of ageing might mean and argue that (...)
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  82.  1
    Assessment of Orientation Practices for Ethics Consultation at Harvard Medical School-Affiliated Hospitals.Danish Zaidi & Jennifer C. Kesselheim - 2018 - Journal of Medical Ethics 44 (2):91-96.
    Background Few studies have been conducted to assess the quality of orientation practices for ethics advisory committees that conduct ethics consultation. This survey study focused on several Harvard teaching hospitals, exploring orientation quality and committee members’ self-evaluation in the American Society of Bioethics and Humanities ethics consultation competencies. Methods We conducted a survey study that involved 116 members and 16 chairs of ethics advisory committees, respectively. Predictor variables included professional demographics, duration on committees and level of training. Outcome variables included (...)
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  83.  1
    Medical Students’ Perceptions of Professional Misconduct: Relationship with Typology and Year of Programme.Juliana Zulkifli, Brad Noel, Deirdre Bennett, Siun O’Flynn & Colm O’Tuathaigh - 2018 - Journal of Medical Ethics 44 (2):133-137.
    Aim To examine the contribution of programme year and demographic factors to medical students’ perceptions of evidence-based classification categories of professional misconduct. Methods Students at an Irish medical school were administered a cross-sectional survey comprising 31 vignettes of professional misconduct, which mapped onto a 12-category classification system. Students scored each item using a 5-point Likert scale, where 1 represents the least severe form of misconduct and 5 the most severe. Results Of the 1012 eligible respondents, 561 students completed the survey, (...)
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  84.  1
    Law and the Perils of Philosophical Grafts.Richard E. Ashcroft - 2018 - Journal of Medical Ethics 44 (1):72-72.
    Charles Foster and Jonathan Herring are to be congratulated on their useful presentation of the roles played by concepts of personhood and identity in English medical law.1 However, I fear that the project they have undertaken here is misconceived. It is an interesting and important misconception, which is widely shared in the literature on medical law and ethics; but a misconception it remains. The problem is this. What we call ‘the Law’ is in fact a complex assemblage of institutions, rules, (...)
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  85.  3
    Advances in Neuroscience Imply That Harmful Experiments in Dogs Are Unethical.Jarrod Bailey & Shiranee Pereira - 2018 - Journal of Medical Ethics 44 (1):47-52.
    Functional MRI of fully awake and unrestrained dog ’volunteers' has been proven an effective tool to understand the neural circuitry and functioning of the canine brain. Although every dog owner would vouch that dogs are perceptive, cognitive, intuitive and capable of positive emotions/empathy, as indeed substantiated by ethological studies for some time, neurological investigations now corroborate this. These studies show that there exists a striking similarity between dogs and humans in the functioning of the caudate nucleus, and dogs experience positive (...)
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  86.  5
    Dignitarian Medical Ethics.Barclay Linda - 2018 - Journal of Medical Ethics 44 (1):62-67.
    Philosophers and bioethicists are typically sceptical about invocations of dignity in ethical debates. Many believe that dignity is essentially devoid of meaning: either a mere rhetorical gesture used in the absence of good argument or a faddish term for existing values like autonomy and respect. On the other hand, the patient experience of dignity is a substantial area of research in healthcare fields like nursing and palliative care. In this paper, it is argued that philosophers have much to learn from (...)
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  87.  14
    A Libertarian Case for Mandatory Vaccination.Jason Brennan - 2018 - Journal of Medical Ethics 44 (1):37-43.
    This paper argues that mandatory, government-enforced vaccination can be justified even within a libertarian political framework. If so, this implies that the case for mandatory vaccination is very strong indeed as it can be justified even within a framework that, at first glance, loads the philosophical dice against that conclusion. I argue that people who refuse vaccinations violate the ‘clean hands principle’, a moral principle that prohibits people from participating in the collective imposition of unjust harm or risk of harm. (...)
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  88.  3
    The Ebola Clinical Trials: A Precedent for Research Ethics in Disasters.Philippe Calain - 2018 - Journal of Medical Ethics 44 (1):3-8.
    The West African Ebola epidemic has set in motion a collective endeavour to conduct accelerated clinical trials, testing unproven but potentially lifesaving interventions in the course of a major public health crisis. This unprecedented effort was supported by the recommendations of an ad hoc ethics panel convened in August 2014 by the WHO. By considering why and on what conditions the exceptional circumstances of the Ebola epidemic justified the use of unproven interventions, the panel's recommendations have challenged conventional thinking about (...)
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  89.  1
    Ethics Consultation in Paediatric and Adult Emergency Departments: An Assessment of Clinical, Ethical, Learning and Resource Needs.Keith A. Colaco, Alanna Courtright, Sandra Andreychuk, Andrea Frolic, Ji Cheng & April Jacqueline Kam - 2018 - Journal of Medical Ethics 44 (1):13-20.
    Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments in order to build ethics capacity and provide a foundation for the development of an ethics education programme. Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. Results Of the (...)
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  90.  5
    How Do Clinicians Prepare Family Members for the Role of Surrogate Decision-Maker?V. Cunningham Thomas, P. Scheunemann Leslie, M. Arnold Robert & White Douglas - 2018 - Journal of Medical Ethics 44 (1):21-26.
    Purpose Although surrogate decision-making is prevalent in intensive care units and concerns with decision quality are well documented, little is known about how clinicians help family members understand the surrogate role. We investigated whether and how clinicians provide normative guidance to families regarding how to function as a surrogate. Subjects and methods We audiorecorded and transcribed 73 ICU family conferences in which clinicians anticipated discussing goals of care for incapacitated patients at high risk of death. We developed and applied a (...)
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  91.  5
    Identity, Personhood and the Law: Charles Foster and Jonathan Herring. Springer, 2017: ISBN 978-3-319-53458-9: 70 Pp. [REVIEW]Foster Charles & Herring Jonathan - 2018 - Journal of Medical Ethics 44 (1):00-00.
    The law tends to think that there is no difficulty about identifying humans. When someone is born, her name is entered into a statutory register. She is ‘X’ in the eyes of the law. At some point, ‘X’ will die and her name will be recorded in another register. If anyone suggested that the second X was not the same as the first, the suggestion would be met with bewilderment. During X's lifetime, the civil law assumed that the X who (...)
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  92.  6
    Identity, Personhood and the Law: A Response to Ashcroft and McGee.Charles Foster & Jonathan Herring - 2018 - Journal of Medical Ethics 44 (1):73-74.
    We are very grateful to Richard Ashcroft1 and Andrew McGee2 for their thoughtful and articulate criticisms of our views.3 Ashcroft has disappointingly low aspirations for the law. Of course he is right to say that the law is not a ‘self-sufficient, integrated and self-interpreting system of doctrine’. The law is often philosophically incoherent and internally contradictory. But it does not follow from this that all areas of the law are philosophically unsatisfactory. And if that were true, the response should not (...)
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  93.  9
    Personal Responsibility Within Health Policy: Unethical and Ineffective.Phoebe Friesen - 2018 - Journal of Medical Ethics 44 (1):53-58.
    This paper argues against incorporating assessments of individual responsibility into healthcare policies by expanding an existing argument and offering a rebuttal to an argument in favour of such policies. First, it is argued that what primarily underlies discussions surrounding personal responsibility and healthcare is not causal responsibility, moral responsibility or culpability, as one might expect, but biases towards particular highly stigmatised behaviours. A challenge is posed for proponents of taking personal responsibility into account within health policy to either expand the (...)
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  94.  2
    Aspects of Disaster Research Ethics Applicable to Other Contexts.Bridget Haire - 2018 - Journal of Medical Ethics 44 (1):9-10.
    In his article ‘The Ebola Clinical Trials: a precedent for research ethics in disasters’, Philippe Calain constructs a compelling case as to why and how experiences from the recent Ebola epidemic should be used to develop a framework for disaster research ethics. In particular, Calain proposes a useful model for assessing whether or not an unproven intervention could be suitable for human use in a disaster context, and makes a powerful argument against the separation of patient care from research goals. (...)
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  95.  3
    Ethics of Fertility Preservation for Prepubertal Children: Should Clinicians Offer Procedures Where Efficacy is Largely Unproven?Rosalind J. McDougall, Lynn Gillam, Clare Delany & Yasmin Jayasinghe - 2018 - Journal of Medical Ethics 44 (1):27-31.
    Young children with cancer are treated with interventions that can have a high risk of compromising their reproductive potential. ‘Fertility preservation’ for children who have not yet reached puberty involves surgically removing and cryopreserving reproductive tissue prior to treatment in the expectation that strategies for the use of this tissue will be developed in the future. Fertility preservation for prepubertal children is ethically complex because the techniques largely lack proven efficacy for this age group. There is professional difference of opinion (...)
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  96.  3
    Reasons, Causes and Identity.Andrew McGee - 2018 - Journal of Medical Ethics 44 (1):70-71.
    In their book Identity, Personhood and the Law,1 authors Charles Foster and Jonathan Herring seek, among other things, to show that the law is based on overly simplistic assumptions about the nature of personal identity. In their Author Meets Critics précis, they summarise the main contentions of the book on this issue. Difficulties in the law’s simplistic approach are, they claim, exposed when we think about people with dementia, ‘where [in advanced cases] I may turn into a person with no (...)
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  97.  4
    Should Neurotechnological Treatments Offered to Offenders Always Be in Their Best Interests?Thomas Søbirk Petersen - 2018 - Journal of Medical Ethics 44 (1):32-36.
    The paper critically discusses the moral view that neurotechnological behavioural treatment for criminal offenders should only be offered if it is in their best interests. First, I show that it is difficult to apply and assess the notion of the offender's best interests unless one has a clear idea of what ‘best interests’ means. Second, I argue that if one accepts that harmful punishment of offenders has a place in the criminal justice system, it seems inconsistent not to accept the (...)
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  98.  10
    Navigating Individual and Collective Interests in Medical Ethics.Jonathan Pugh - 2018 - Journal of Medical Ethics 44 (1):1-2.
    In medical ethics, we are often concerned with questions that pertain predominantly to the treatment of a particular individual. However, in a number of cases it is crucial to broaden the scope of our moral inquiry beyond consideration of the individual alone, since the interests of the individual can come into conflict with the interests of the wider community. How should we resolve such conflicts between the interests of the individual and the collective? Most readers of this journal will likely (...)
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  99.  1
    Individual and Public Interests in Clinical Research During Epidemics: A Reply to Calain.Annette Rid - 2018 - Journal of Medical Ethics 44 (1):11-12.
    In his stimulating target article,1 Philippe Calain discusses how the traditional ethical framework for clinical research was challenged during the 2013–2016 Ebola epidemic in West Africa. One of his key claims is that conventional research ethics did not have the resources to address the ‘profound tension’1, between individual and public interests in clinical research during this epidemic. I agree with this claim, but would like to provide a modified argument in its support. As Calain points out, although a tension between (...)
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  100.  7
    Golden Opportunity, Reasonable Risk and Personal Responsibility for Health.Julian Savulescu - 2018 - Journal of Medical Ethics 44 (1):59-61.
    In her excellent and comprehensive article, Friesen argues that utilising personal responsibility in healthcare is problematic in several ways: it is difficult to ascribe responsibility to behaviour; there is a risk of prejudice and bias in deciding which behaviours a person should be held responsible for; it may be ineffective at reducing health costs. In this short commentary, I will elaborate the critique of personal responsibility in health but suggest one way in which it could be used ethically. In doing (...)
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  101.  6
    The UK Mental Capacity Act and Consent to Research Participation: Asking the Right Question.Willner Paul - 2018 - Journal of Medical Ethics 44 (1):44-46.
    This paper considers the meaning of the term ‘intrusive research’, as used in the UK Mental Capacity Act 2005, in relation to studies in which an informant is asked to provide information about or on behalf of a person who lacks capacity to consent, and who is not otherwise involved in the study. The MCA defines ‘intrusive research’ as research that would legally require consent if it involved people with capacity. The relevant ethical principles are that consent should be sought (...)
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