Year:

  1.  2
    Endangerment of the iPSC Stock Project in Japan: On the Ethics of Public Funding Policies.Akira Akabayashi, Eisuke Nakazawa & Nancy S. Jecker - 2018 - Journal of Medical Ethics 44 (10):700-702.
    We examined the ethical justification for a national policy governing public funding for the induced pluripotent stem cell stock project in Japan and argue that the initiation of the iPSC stock project in 2012, when no clinical trial using iPSC-derived products had yet succeeded, was premature and unethical. Our analysis considers a generally accepted justice criterion and shows it fails to justify public funding of the iPSC stock project. We also raise concerns related to the massive amounts of public funding (...)
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  2.  29
    Substituted Decision Making and the Dispositional Choice Account.Anna-Karin Margareta Andersson & Kjell Arne Johansson - 2018 - Journal of Medical Ethics 44 (10):703-709.
    There are two main ways of understanding the function of surrogate decision making in a legal context: the Best Interests Standard and the Substituted Judgment Standard. First, we will argue that the Best Interests Standard is difficult to apply to unconscious patients. Application is difficult regardless of whether they have ever been conscious. Second, we will argue that if we accept the least problematic explanation of how unconscious patients can have interests, we are also obliged to accept that the Substituted (...)
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  3.  3
    Respectful Care of Human Dignity: How is It Perceived by Patients and Nurses?Rahime Aydın Er, Aysel İncedere & Selda Öztürk - 2018 - Journal of Medical Ethics 44 (10):675-680.
    Objective Dignified care protects the patient’s rights and provides appropriate ethical care while improving the quality of nursing care. In this context, the opinions of nurses and patients who receive nursing care about dignified care are important. The aim of this study was to explore the opinions and experiences of Turkish patients and nurses about respectful care of human dignity. Methods This descriptive cross-sectional study was conducted in Turkey. Participants were inpatients at cardiology, neurology and neurosurgery clinics and nurses working (...)
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  4.  3
    When Slippery Slope Arguments Miss the Mark: A Lesson From One Against Physician-Assisted Death.Eric Blackstone & Stuart J. Youngner - 2018 - Journal of Medical Ethics 44 (10):657-660.
    In 1989, Susan Wolf convincingly warned of a troublesome consequence that should discourage any movement in American society towards physician-assisted death—a legal backlash against the gains made for limiting life-sustaining treatment. The authors demonstrate that this dire consequence did not come to pass. As physician-assisted suicide gains a foothold in USA and elsewhere, many other slippery slope arguments are being put forward. Although many of these speculations should be taken seriously, they do not justify halting the new practice. Instead, our (...)
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  5.  1
    Ethics Briefing.Martin Davies, Ruth Campbell, Sophie Brannan, Veronica English, Rebecca Mussell & Julian C. Sheather - 2018 - Journal of Medical Ethics 44 (10):725-726.
    The Supreme Court has ruled in the case of Y that there is no requirement to seek the approval of the Court of Protection in decisions to withdraw clinically assisted nutrition and hydration from patients in a prolonged disorder of consciousness.1 Mr Y was 52-year-old man who suffered a cardiac arrest after a myocardial infarction as a result of coronary artery disease. It was not possible to resuscitate him for well over 10 min, resulting in severe cerebral hypoxia which caused (...)
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  6.  3
    Response to Sheehan Et Al’s ‘In Defence of Governance: Ethics Review and Social Research’.Martyn Hammersley - 2018 - Journal of Medical Ethics 44 (10):717-718.
    This response welcomes Sheehan et al ’s discussion of the criticisms that have been made of mandatory, pre-emptive ethics regulation and their outline of a philosophical rationale for it. However, it is argued that they misrepresent some of the key criticisms and fail to provide any effective response to them.
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  7.  2
    Transplants for Non-Lethal Conditions: A Case Against Hand Transplantation in Minors.Charles E. Hedges & Philip M. Rosoff - 2018 - Journal of Medical Ethics 44 (10):661-665.
    Human allografts for life-threatening organ failure have been demonstrated to be lifesaving and are now considered to be standard of care for many conditions. Transplantation of non-vital anatomic body parts has also been accomplished. Hand transplantation after limb loss in adults has been shown to offer some promising benefits in both functional and psychological measures in preliminary studies. It has been suggested to expand eligibility criteria to include minors, with one such operation having already been performed. With this in mind, (...)
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  8.  10
    Autonomy, Nudging and Post-Truth Politics.Geoff Keeling - 2018 - Journal of Medical Ethics 44 (10):721-722.
    In his excellent essay, ‘Nudges in a post-truth world’, Neil Levy argues that ‘nudges to reason’, or nudges which aim to make us more receptive to evidence, are morally permissible. A strong argument against the moral permissibility of nudging is that nudges fail to respect the autonomy of the individuals affected by them. Levy argues that nudges to reason do respect individual autonomy, such that the standard autonomy objection fails against nudges to reason. In this paper, I argue that Levy (...)
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  9.  2
    How Important is Social Support in Determining Patients’ Suitability for Transplantation? Results From a National Survey of Transplant Clinicians.Keren Ladin, Joanna Emerson, Zeeshan Butt, Elisa J. Gordon, Douglas W. Hanto, Jennifer Perloff, Norman Daniels & Tara A. Lavelle - 2018 - Journal of Medical Ethics 44 (10):666-674.
    Background National guidelines require programmes use subjective assessments of social support when determining transplant suitability, despite limited evidence linking it to outcomes. We examined how transplant providers weigh the importance of social support for kidney transplantation compared with other factors, and variation by clinical role and personal beliefs. Methods The National survey of the American Society of Transplant Surgeons and the Society of Transplant Social Work in 2016. Using a discrete choice approach, respondents compared two hypothetical patient profiles and selected (...)
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  10.  8
    Nudges to Reason: Not Guilty.Neil Levy - 2018 - Journal of Medical Ethics 44 (10):723-723.
    I am to grateful to Geoff Keeling for his perceptive response1 to my paper.2 In this brief reply, I will argue that he does not succeed in his goal of showing that nudges to reason do not respect autonomy. At most, he establishes only that such nudges may threaten autonomy when used in certain ways and in certain circumstances. As I will show, this is not a conclusion that should give us grounds for particular concerns about nudges. Before turning to (...)
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  11.  2
    A Mobile Revolution for Healthcare? Setting the Agenda for Bioethics.Federica Lucivero & Karin R. Jongsma - 2018 - Journal of Medical Ethics 44 (10):685-689.
    Mobile health is rapidly being implemented and changing our ways of doing, understanding and organising healthcare. mHealth includes wearable devices as well as apps that track fitness, offer wellness programmes or provide tools to manage chronic conditions. According to industry and policy makers, these systems offer efficient and cost-effective solutions for disease prevention and self-management. While this development raises many ethically relevant questions, so far mHealth has received only little attention in medical ethics. This paper provides an overview of bioethical (...)
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  12.  2
    Diversity of Scholarship in Medical Ethics.Rosalind J. McDougall - 2018 - Journal of Medical Ethics 44 (10):655-656.
    In their essay arguing for ethical review of social research, Sheehan et al write: > Inquiry and human life are intertwined and interdependent. To be human is to be curious, to ask questions about yourself, the world, and your place in the world. This process of inquiry is undertaken individually, but is a social activity.1 As researchers in medical ethics, all the authors in this issue have chosen to ask a particular type of question about the world: questions about ethical (...)
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  13.  3
    Should All Medical Research Be Published? The Moral Responsibility of Medical Journal Editors.Thomas Ploug - 2018 - Journal of Medical Ethics 44 (10):690-694.
    This article reinvigorates a key question in publication ethics: Is there research that it is permissible to conduct but that ought not to be published? The article raises the question in relation to two recent medical studies. It is argued that the publication of these studies may cause significant harm to individuals, that editors of medical journals have a moral responsibility for such harm, that denial of publication is inadequate as an instrument to fulfil this moral responsibility and that internationally (...)
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  14.  7
    How Altruistic Organ Donation May Be Bad.Ben Saunders - 2018 - Journal of Medical Ethics 44 (10):681-684.
    It has traditionally been assumed that organ donation must be altruistic, though the necessity of altruistic motivations has recently been questioned. Few, however, have questioned whether altruism is always a good motive. This paper considers the possibility that excessive altruism, or self-abnegation, may be intrinsically bad. How this may be so is illustrated with reference to Tom Hurka’s account of the value of attitudes, which suggests that disproportionate love of one’s own good—either excessive or deficient—is intrinsically bad. Whether or not (...)
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  15.  4
    In Defence of Governance: Ethics Review and Social Research.Mark Sheehan, Michael Dunn & Kate Sahan - 2018 - Journal of Medical Ethics 44 (10):710-716.
    There is a growing body of literature that has sought to undermine systems of ethical regulation, and governance more generally, within the social sciences. In this paper, we argue that any general claim for a system of research ethics governance in social research depends on clarifying the nature of the stake that society has in research. We show that certain accounts of this stake—protecting researchers’ freedoms; ensuring accountability for resources; safeguarding welfare; and supporting democracy—raise relevant ethical considerations that are reasonably (...)
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  16.  3
    Reasonable Disagreement and the Justification of Pre-Emptive Ethics Governance in Social Research: A Response to Hammersley.Mark Sheehan, Michael Dunn & Kate Sahan - 2018 - Journal of Medical Ethics 44 (10):719-720.
    In this response, we first tackle what we take to be the core disagreement between ourselves and Hammersley, namely the justification for our model of social research ethics governance. We then consider what follows from our defence of governance for ethics review and show how these claims attend to the specific concerns outlined by Hammersley.
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  17.  2
    Ethics of Dead Participants: Policy Recommendations for Biobank Research.Lars Ursin & Maria Stuifbergen - 2018 - Journal of Medical Ethics 44 (10):695-699.
    Respecting people’s consent choices for use of their material and data is a cornerstone of biobank ethics. Participation in biobanks is characteristically based on broad consent that presupposes an ongoing possibility of informing and interacting with participants over time. The death of a participant means the end of any interaction, but usually not the end of participation. Research on causes of death makes biobank material from deceased participants extremely valuable. But as new research questions and methods develop over time, the (...)
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  18.  6
    Consenting to Invasive Contraceptives: An Ethical Analysis of Adolescent Decision-Making Authority for Long-Acting Reversible Contraception.Rosemary Talbot Behmer Hansen & Kavita Shah Arora - 2018 - Journal of Medical Ethics 44 (9):585-588.
    Since USA constitutional precedent established in 1976, adolescents have increasingly been afforded the right to access contraception without first obtaining parental consent or authorisation. There is general agreement this ethically permissible. However, long-acting reversible contraception methods have only recently been prescribed to the adolescent population. They are currently the most effective forms of contraception available and have high compliance and satisfaction rates. Yet unlike other contraceptives, LARCs are associated with special procedural risks because they must be inserted and removed by (...)
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  19.  2
    Is There a Nocebo Response That Results From Disease Awareness Campaigns and Advertising in Australia, and Can This Effect Be Mitigated?Stuart Benson & David Hunter - 2018 - Journal of Medical Ethics 44 (9):621-625.
    Direct-to-consumer advertising is banned in Australia, and instead pharmaceutical companies use disease awareness campaigns as a strategy to raise public awareness of conditions for which the company produces a treatment. This practice has been justified by promoting individual autonomy and public health, but it has attracted criticism regarding medicalisation of normal health and ageing, and exaggeration of the severity of the condition in question, imbalanced reporting of risks and benefits, and damaging the patient–clinician relationship. While there are benefits of disease (...)
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  20.  3
    Questioning Previously Accepted Principles.Kenneth Boyd - 2018 - Journal of Medical Ethics 44 (9):583-584.
    In the late 1980s, an Institute of Medical Ethics working party on the teaching of medical ethics defined the subject as follows.1 Medical Ethics, it stated, has ‘two meanings’: ‘traditionally’ it ‘has referred to the standards of professional competence and conduct which the medical profession requires of its members’; ‘increasingly’, it ‘refers to the study of ethical or moral problems raised by the practice of medicine’. Thirty years on, teaching, learning and research in medical ethics retains this dual emphasis on (...)
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  21.  3
    Ethics Briefing.Sophie Brannan, Ruth Campbell, Martin Davies, Veronica English, Rebecca Mussell & Julian C. Sheather - 2018 - Journal of Medical Ethics 44 (9):653-654.
    Essex University, in association with Johns Hopkins Center for Public Health and Human Rights, has brought out a timely report highlighting the increasing global criminalisation of the provision of healthcare.1 The report, with a foreword by Professor Dainius Puras, United Nations Special Rapporteur on the right to health, explores the pressures on medical impartiality arising in large part from both global and national responses to the threat of terrorism. Both international humanitarian law, human rights law and long-established principles of medical (...)
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  22.  2
    Wearing Humanism on Your Sleeve.Jason J. DuBroff - 2018 - Journal of Medical Ethics 44 (9):646-647.
    Two years ago, like many of my peers, the years of preparation to become a medical student culminated in one single act: the white coat ceremony. After awkwardly lowering myself before my dean with arms extended behind me, my ephemeral initiation into medicine passed as we both wrestled the coat on. I did not think much about the white coat after the white coat ceremony, but something began to itch my neck every time I wore my coat. It was not (...)
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  23.  1
    Commentary on ‘Wearing Humanism on Your Sleeve’.Shimon M. Glick - 2018 - Journal of Medical Ethics 44 (9):648-648.
    I was deeply moved and inspired by Jason Dubroff’s article1 objecting to the source of the white coat distributed to the entering medical students at his school. The article stimulated me to ponder its implications and led to some thoughtful discussions with colleagues. Here was a busy medical student who was appropriately disturbed at what he regarded as a kind of ethical failure at the very ceremony, which was meant to exemplify and emphasise the values of humanism. However, unlike many (...)
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  24.  1
    Device Representatives in Hospitals: Are Commercial Imperatives Driving Clinical Decision-Making?Quinn Grundy, Katrina Hutchison, Jane Johnson, Brette Blakely, Robyn Clay-Wlliams, Bernadette Richards & Wendy A. Rogers - 2018 - Journal of Medical Ethics 44 (9):589-592.
    Despite concerns about the relationships between health professionals and the medical device industry, the issue has received relatively little attention. Prevalence data are lacking; however, qualitative and survey research suggest device industry representatives, who are commonly present in clinical settings, play a key role in these relationships. Representatives, who are technical product specialists and not necessarily medically trained, may attend surgeries on a daily basis and be available to health professionals 24 hours a day, 7 days a week, to provide (...)
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  25.  1
    Thinking Clearly About the FIRST Trial: Addressing Ethical Challenges in Cluster Randomised Trials of Policy Interventions Involving Health Providers.Austin R. Horn, Charles Weijer, Spencer Phillips Hey, Jamie Brehaut, Dean A. Fergusson, Cory E. Goldstein, Jeremy Grimshaw & Monica Taljaard - 2018 - Journal of Medical Ethics 44 (9):593-598.
    The ethics of the Flexibility In duty hour Requirements for Surgical Trainees trial have been vehemently debated. Views on the ethics of the FIRST trial range from it being completely unethical to wholly unproblematic. The FIRST trial illustrates the complex ethical challenges posed by cluster randomised trials of policy interventions involving healthcare professionals. In what follows, we have three objectives. First, we critically review the FIRST trial controversy, finding that commentators have failed to sufficiently identify and address many of the (...)
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  26.  3
    Ethics of Routine: A Critical Analysis of the Concept of ‘Routinisation’ in Prenatal Screening.Adriana Kater-Kuipers, Inez D. De Beaufort, Robert-Jan H. Galjaard & Eline M. Bunnik - 2018 - Journal of Medical Ethics 44 (9):626-631.
    In the debate surrounding the introduction of non-invasive prenatal testing in prenatal screening programmes, the concept of routinisation is often used to refer to concerns and potential negative consequences of the test. A literature analysis shows that routinisation has many different meanings, which can be distinguished in three major versions of the concept. Each of these versions comprises several inter-related fears and concerns regarding prenatal screening and particularly regarding NIPT in three areas: informed choice, freedom to choose and consequences for (...)
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  27.  3
    Duty to Provide Care to Ebola Patients: The Perspectives of Guinean Lay People and Healthcare Providers.Lonzozou Kpanake, Tamba Kallas Tonguino, Paul Clay Sorum & Etienne Mullet - 2018 - Journal of Medical Ethics 44 (9):599-605.
    Aim To examine the views of Guinean lay people and healthcare providers regarding the acceptability of HCPs’ refusal to provide care to Ebola patients. Method From October to December 2015, lay people and HCPs in Conakry, Guinea, were presented with 54 sample case scenarios depicting a HCP who refuses to provide care to Ebola patients and were instructed to rate the extent to which this HCP’s decision is morally acceptable. The scenarios were composed by systematically varying the levels of four (...)
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  28.  6
    Cerebral Organoids: Ethical Issues and Consciousness Assessment.Andrea Lavazza & Marcello Massimini - 2018 - Journal of Medical Ethics 44 (9):606-610.
    Organoids are three-dimensional biological structures grown in vitro from different kinds of stem cells that self-organise mimicking real organs with organ-specific cell types. Recently, researchers have managed to produce human organoids which have structural and functional properties very similar to those of different organs, such as the retina, the intestines, the kidneys, the pancreas, the liver and the inner ear. Organoids are considered a great resource for biomedical research, as they allow for a detailed study of the development and pathologies (...)
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  29.  4
    Cerebral Organoids and Consciousness: How Far Are We Willing to Go?Andrea Lavazza & Marcello Massimini - 2018 - Journal of Medical Ethics 44 (9):613-614.
    In his interesting commentary, Joshua Shepherd raises two points—one related to epistemology, the other to ethics—about our article on human cerebral organoids.1 2 From the epistemological standpoint, he calls into question the need for a theory of consciousness. A theory of consciousness, for him, is not necessary because of the lack of consensus about the very nature of consciousness. Shepherd suggests that ‘given widespread disagreement, applying a theory of consciousness may not be helpful when attempting to diagnose the presence of (...)
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  30.  4
    Dignity and Equality in Healthcare.Pengbo Liu - 2018 - Journal of Medical Ethics 44 (9):651-652.
    This paper critically examines Barclay’s conception of dignity proposed in her ‘Dignitarian Medical Ethics’. According to Barclay, a subject S enjoys dignity if and only if S is reliably treated as having equal social status. I argue that Barclay’s view faces a number of practical and theoretical problems. First, it is not obvious that failing to treat someone as a social equal is incompatible with respecting her dignity. Second, it is not always clear what treating someone as a social equal (...)
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  31. Development of a Consensus Approach for Return of Pathology Incidental Findings in the Genotype-Tissue Expression Project.Nicole C. Lockhart, Carol J. Weil, Latarsha J. Carithers, Susan E. Koester, A. Roger Little, Simona Volpi, Helen M. Moore & Benjamin E. Berkman - 2018 - Journal of Medical Ethics 44 (9):643-645.
    The active debate about the return of incidental or secondary findings in research has primarily focused on return to research participants, or in some cases, family members. Particular attention has been paid to return of genomic findings. Yet, research may generate other types of findings that warrant consideration for return, including findings related to the pathology of donated biospecimens. In the case of deceased biospecimen donors who are also organ and/or tissue transplant donors, pathology incidental findings may be relevant not (...)
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  32.  1
    Examining the Use of ‘Natural’ in Breastfeeding Promotion: Ethical and Practical Concerns.Jessica Martucci & Anne Barnhill - 2018 - Journal of Medical Ethics 44 (9):615-620.
    References to the ‘natural’ are common in public health messaging about breastfeeding. For example, the WHO writes that ‘Breast milk is the natural first food for babies’ and the U.S. Department of Health and Human Services has a breastfeeding promotion campaign called ‘It’s only natural’, which champions breastfeeding as the natural way to feed a baby. This paper critically examines the use of ‘natural’ language in breastfeeding promotion by public health and medical bodies. A pragmatic concern with selling breastfeeding as (...)
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  33.  2
    What Makes Clinical Labour Different? The Case of Human Guinea Pigging.Joanna Różyńska - 2018 - Journal of Medical Ethics 44 (9):638-642.
    Each year thousands of individuals enrol in clinical trials as healthy volunteers to earn money. Some of them pursue research participation as a full-time or at least a part-time job. They call themselves professional or semiprofessional guinea pigs. The practice of paying healthy volunteers raises numerous ethical concerns. Different payment models have been discussed in literature. Dickert and Grady argue for a wage-payment model. This model gives research subjects a standardised hourly wage, and it is based on an assumption that (...)
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  34. Mistakes and Missed Opportunities Regarding Cosmetic Surgery and Conscientious Objection.Toni C. Saad - 2018 - Journal of Medical Ethics 44 (9):649-650.
    In her paper ‘Cosmetic surgery and conscientious objection’, Minerva rightly identifies cosmetic surgery as an interesting test case for the question of conscientious objection in medicine. Her treatment of this important subject, however, seems problematic. It is argued that Minerva's suggestion that a doctor has a prima facie duty to satisfy patient preferences even against his better clinical judgment, which we call Patient Preference Absolutism, must be regarded with scepticism. This is because it overlooks an important distinction regarding autonomy's meaning (...)
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  35.  5
    Ethical Issues Regarding Consciousness in Cerebral Organoids.Joshua Shepherd - 2018 - Journal of Medical Ethics 44 (9):611-612.
    In this interesting paper, Lavazza and Massimini draw attention to a subset of the ethical issues surrounding the development and potential uses of cerebral organoids. This subset concerns the possibility that cerebral organoids may one day develop phenomenal consciousness, and thereby qualify as conscious subjects—that there may one day be something it is like to be an advanced cerebral organoid. This possibility may feel outlandish. But as Lavazza and Massimini demonstrate, the science of organoids is moving fast, and I agree (...)
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  36.  4
    Healthcare Professionals’ Understanding of the Legislation Governing Research Involving Adults Lacking Mental Capacity in England and Wales: A National Survey.Victoria Shepherd, Richard Griffith, Mark Sheehan, Fiona Wood & Kerenza Hood - 2018 - Journal of Medical Ethics 44 (9):632-637.
    Objective To examine health and social care professionals’ understanding of the legislation governing research involving adults lacking mental capacity in England and Wales. Methods A cross-sectional online survey was conducted using a series of vignettes. Participants were asked to select the legally authorised decision-maker in each scenario and provide supporting reasons. Responses were compared with existing legal frameworks and analysed according to their level of concordance. Results One hundred and twenty-seven professionals participated. Levels of discordance between responses and the legal (...)
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  37.  8
    Who Calls the Shots? The Ethics of Adolescentself-Consent for HPV Vaccination.Suchi Agrawal & Stephanie R. Morain - 2018 - Journal of Medical Ethics 44 (8):531-535.
    While the human papillomavirus vaccine is medically indicated to reduce the risk of genital warts and certain types of cancer, rates of HPV vaccination repeatedly fall short of public health goals. Individual-level factors contributing to low vaccination rates are well documented. However, system-level barriers, particularly the need for parental consent, have been less explored. To date, there is no legal or ethical consensus in the USA regarding whether adolescents might permissibly self-consent to the HPV vaccine. Consequently, there is considerable variability (...)
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  38.  9
    Truth Be Told: Not All Nudging is Bullshit.Jennifer Blumenthal-Barby & Peter A. Ubel - 2018 - Journal of Medical Ethics 44 (8):547-547.
    > ‘The fact about himself that the bullshitter hides, on the other hand, is that the truth-values of his statements are of no central interest to him; what we are not to understand is that his intention is neither to report the truth nor conceal it. It is just this lack of connection to a concern with truth—this indifference to how things really are—that is the essence of bullshit.’1 > —Harry Frankfurt In his paper, Nudging, informed consent, and bullshit, William (...)
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  39.  4
    Truthful Nudging.Shlomo Cohen - 2018 - Journal of Medical Ethics 44 (8):545-546.
    Zealous nudging can deteriorate into paternalistic bullshitting. To the extent that William Simkulet’s paper is a reminder against that danger, it does us good service.1 Simkulet, however, makes the far bolder claims that nudging just is bullshitting and that—since bullshitting deviates from truthfulness, and truthful disclosure is essential for valid consent—nudging invalidates informed consent. These bolder claims involve a set of errors. The problem starts with Simkulet’s formal definition of ‘bullshit’, which says that conveying x while intending one’s audience to (...)
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  40.  1
    Ensuring Respect for Persons in COMPASS: A Cluster Randomised Pragmatic Clinical Trial.Joseph E. Andrews, J. Brian Moore, Richard B. Weinberg, Mysha Sissine, Sabina Gesell, Jacquie Halladay, Wayne Rosamond, Cheryl Bushnell, Sara Jones, Paula Means, Nancy M. P. King, Diana Omoyeni & Pamela W. Duncan - 2018 - Journal of Medical Ethics 44 (8):560-566.
    Cluster randomised clinical trials present unique challenges in meeting ethical obligations to those who are treated at a randomised site. Obtaining informed consent for research within the context of clinical care is one such challenge. In order to solve this problem it is important that an informed consent process be effective and efficient, and that it does not impede the research or the healthcare. The innovative approach to informed consent employed in the COMPASS study demonstrates the feasibility of upholding ethical (...)
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  41.  2
    NHS Constitution Values for Values-Based Recruitment: A Virtue Ethics Perspective.Johanna Elise Groothuizen, Alison Callwood & Ann Gallagher - 2018 - Journal of Medical Ethics 44 (8):518-523.
    Values-based recruitment is used in England to select healthcare staff, trainees and students on the basis that their values align with those stated in the Constitution of the UK National Health Service. However, it is unclear whether the extensive body of existing literature within the field of moral philosophy was taken into account when developing these values. Although most values have a long historical tradition, a tendency to assume that they have just been invented, and to approach them uncritically, exists (...)
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  42.  10
    Disabling Disability Amid Competing Ideologies.Tom Koch - 2018 - Journal of Medical Ethics 44 (8):575-579.
    This paper critiques current arguments advancing the potential for transhumanism and a range of biological and pharmacological enhancements to better human flourishing. It does so from a historical perspective weighing the individualistic and competitive evolutionary theories of Darwin with the cooperative and communal theories of Prince Peter Kropotkin a generation later. In doing so it proposes the transhumanist and enhancement enthusiasts operate within a paradigm similar to Darwin’s, one that is atomist and individualistic. The critique, which considers the status of (...)
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  43.  1
    Ethical Arguments for Access to Abortion Services in the Republic of Ireland: Recent Developments in the Public Discourse.Joan McCarthy, Katherine O’Donnell, Louise Campbell & Dolores Dooley - 2018 - Journal of Medical Ethics 44 (8):513-517.
    The Republic of Ireland has some of the most restrictive abortion legislation in the world which grants to the ‘unborn’ an equal right to life to that of the pregnant woman. This article outlines recent developments in the public discourse on abortion in Ireland and explains the particular cultural and religious context that informs the ethical case for access to abortion services. Our perspective rests on respect for two very familiar moral principles – autonomy and justice – which are at (...)
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  44.  3
    Good Medical Ethics.John McMillan - 2018 - Journal of Medical Ethics 44 (8):511-512.
    The first editorial in the Journal of Medical Ethics described an ambition to be a ‘forum for the reasoned discussion of moral issues arising from the provision of medical care’.1 While that statement of intent might seem broad, it is one that has been reaffirmed by successive editors of the journal.2–4 It is an aim that aligns with the mission statement of JME and The Institute of Medical Ethics, to promote ‘ethical reflection and conduct in scientific research and medical conduct.’ (...)
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  45.  2
    Newborn Health Benefits or Financial Risk Protection? An Ethical Analysis of a Real-Life Dilemma in a Setting Without Universal Health Coverage.Kristine Husøy Onarheim, Ole Frithjof Norheim & Ingrid Miljeteig - 2018 - Journal of Medical Ethics 44 (8):524-530.
    Introduction High healthcare costs make illness precarious for both patients and their families’ economic situation. Despite the recent focus on the interconnection between health and financial risk at the systemic level, the ethical conflict between concerns for potential health benefits and financial risk protection at the household level in a low-income setting is less understood. Methods Using a seven-step ethical analysis, we examine a real-life dilemma faced by families and health workers at the micro level in Ethiopia and analyse the (...)
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  46.  2
    So Not Mothers: Responsibility for Surrogate Orphans.Jennifer A. Parks & Timothy F. Murphy - 2018 - Journal of Medical Ethics 44 (8):551-554.
    The law ordinarily recognises the woman who gives birth as the mother of a child, but in certain jurisdictions, it will recognise the commissioning couple as the legal parents of a child born to a commercial surrogate. Some commissioning parents have, however, effectively abandoned the children they commission, and in such cases, commercial surrogates may find themselves facing unexpected maternal responsibility for children they had fully intended to give up. Any assumption that commercial surrogates ought to assume maternal responsibility for (...)
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  47.  1
    Physicians’ Framing and Recommendations. Are They Nudging? And Do They Violate the Requirements of Informed Consent?Thomas Ploug - 2018 - Journal of Medical Ethics 44 (8):543-544.
    In his recent article ‘Nudging, Informed Consent and Bullshit’, William Simkulet1 convincingly argues that certain types of nudging satisfy Frankfurt’s criteria of bullshit. As a prelude to this argument, Simkulet considers whether recommendations and framing are types of nudging and whether they satisfy the requirement of adequate disclosure essential for a valid informed consent. He defines nudging as the systematic attempt at altering behaviour by non-rational means, and describes adequate disclosure as providing the patient with true information that enables an (...)
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  48.  19
    Forgetting Ourselves: Epistemic Costs and Ethical Concerns in Mindfulness Exercises.Sahanika Ratnayake & David Merry - 2018 - Journal of Medical Ethics 44 (8):567-574.
    Mindfulness exercises are presented as being compatible with almost any spiritual, religious or philosophical beliefs. In this paper, we argue that they in fact involve imagining and conceptualising rather striking and controversial claims about the self, and the self’s relationship to thoughts and feelings. For this reason, practising mindfulness exercises is likely to be in tension with many people’s core beliefs and values, a tension that should be treated as a downside of therapeutic interventions involving mindfulness exercises, not unlike a (...)
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  49. Reporting Suspected Abuse or Neglect in Research Involving Children.David B. Resnik & Duncan C. Randall - 2018 - Journal of Medical Ethics 44 (8):555-559.
    In this article, we explore the ethical issues related to the reporting of suspected abuse or neglect in research involving children. Ethical dilemmas related to reporting child maltreatment are often complex because the rights of children and their adult caregivers may conflict and determinations of abuse or neglect are socially constructed judgments that depend on particular circumstances. We argue that when reporting is legally mandated, investigators must follow the law and report their suspicions to Child Protective Services. When reporting is (...)
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  50.  13
    Nudging, Informed Consent and Bullshit.William Simkulet - 2018 - Journal of Medical Ethics 44 (8):536-542.
    Some philosophers have argued that during the process of obtaining informed consent, physicians should try to nudge their patients towards consenting to the option the physician believes best, where a nudge is any influence that is expected to predictably alter a person’s behaviour without restricting her options. Some proponents of nudging even argue that it is a necessary and unavoidable part of securing informed consent. Here I argue that nudging is incompatible with obtaining informed consent. I assume informed consent requires (...)
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  51.  3
    At Odds with the Truth.William Simkulet - 2018 - Journal of Medical Ethics 44 (8):548-550.
    > The bullshitter may not deceive us, or even intend to do so, either about the facts or about what he takes the facts to be. What he does necessarily attempt to deceive us about is his enterprise. His only indispensably distinctive characteristic is that in a certain way he misrepresents what he is up to. 1 - Harry Frankfurt In both lying and truth-telling, the speaker intends the audience to believe what she says is true; that her enterprise is (...)
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  52.  1
    Competition, Cooperation and Human Flourishing: Commentary on Koch.Hazem Zohny - 2018 - Journal of Medical Ethics 44 (8):581-582.
    Mainstream bioethics takes after a competitive, individualistic understanding of biology and is ultimately rooted in libertarian 19th-century values. These in turn drive much of the enthusiasm for transhumanism and explain why disability in bioethics is often characterised as a lamentable deficiency. That, at least, is the concern raised by Tom Koch in his paper Disabling disability amid competing ideologies.1 He contrasts this paradigm with a cooperative, communal understanding of biology, and in turn, of bioethics—one which entails generally prioritising a socially (...)
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  53.  1
    Charlie Gard and the Weight of Parental Rights to Seek Experimental Treatment.Giles Birchley - 2018 - Journal of Medical Ethics 44 (7):448-452.
    The case of Charlie Gard, an infant with a genetic illness whose parents sought experimental treatment in the USA, brought important debates about the moral status of parents and children to the public eye. After setting out the facts of the case, this article considers some of these debates through the lens of parental rights. Parental rights are most commonly based on the promotion of a child’s welfare; however, in Charlie’s case, promotion of Charlie’s welfare cannot explain every fact of (...)
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  54.  1
    Making Medical Decisions for an Incompetent Older Adult When Both a Proxy and an Advance Directive Are Available: Which is More Likely to Reflect the Older Adult’s Preferences?Gina Bravo, Modou Sene & Marcel Arcand - 2018 - Journal of Medical Ethics 44 (7):498-503.
    Objectives To investigate which of two sources of information about an older adult’s wishes—choices made in an advance directive or proxy’s opinion—provides better insight into the older adult’s preferences measured in hypothetical clinical situations involving decisional incapacity. Methods Secondary analyses of data collected from 157 community-dwelling, decisionally competent adults aged 70 years and over who attended a group information session on advance directives with their proxy. Older adults were invited to complete a directive introduced during the session, designed to express (...)
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  55.  1
    A Threshold of Significant Harm or a Viable Alternative Therapeutic Option?Jo Bridgeman - 2018 - Journal of Medical Ethics 44 (7):466-470.
    This article critically examines the legal arguments presented on behalf of Charlie Gard’s parents, Connie Yates and Chris Gard, based on a threshold test of significant harm for intervention into the decisions made jointly by holders of parental responsibility. It argues that the legal basis of the argument, from the case of Ashya King, was tenuous. It sought to introduce different categories of cases concerning children’s medical treatment when, despite the inevitable factual distinctions between individual cases, the duty of the (...)
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  56.  3
    Charlie Gard: In Defence of the Law.Eliana Close, Lindy Willmott & Benjamin P. White - 2018 - Journal of Medical Ethics 44 (7):476-480.
    Much of the commentary in the wake of the Charlie Gard litigation was aimed at apparent shortcomings of the law. These include concerns about the perceived inability of the law to consider resourcing issues, the vagueness of the best interests test and the delays and costs of having disputes about potentially life-sustaining medical treatment resolved by the courts. These concerns are perennial ones that arise in response to difficult cases. Despite their persistence, we argue that many of these criticisms are (...)
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  57.  3
    Ethical Implications of Medical Crowdfunding: The Case of Charlie Gard.Gabrielle Dressler & Sarah A. Kelly - 2018 - Journal of Medical Ethics 44 (7):453-457.
    Patients are increasingly turning to medical crowdfunding as a way to cover their healthcare costs. In the case of Charlie Gard, an infant born with encephalomyopathic mitochondrial DNA depletion syndrome, crowdfunding was used to finance experimental nucleoside therapy. Although this treatment was not provided in the end, we will argue that the success of the Gard family’s crowdfunding campaign reveals a number of potential ethical concerns. First, this case shows that crowdfunding can change the way in which communal healthcare resources (...)
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  58.  1
    Left Of Bang Interventions in Trauma: Ethical Implications for Military Medical Prophylaxis.Neil Eisenstein, David Naumann, Daniel Burns, Sarah Stapley & Heather Draper - 2018 - Journal of Medical Ethics 44 (7):504-508.
    Advances in medical capability should be accompanied by discussion of their ethical implications. In the military medical context there is a growing interest in developing prophylactic interventions that will mitigate the effects of trauma and improve survival. The ethics of this novel capability are currently unexplored. This paper describes the concept of trauma prophylaxis and outlines some of the ethical issues that need to be considered, including within concept development, research and implementation. Trauma prophylaxis can be divided into interventions that (...)
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  59.  7
    Why Charlie Gard’s Parents Should Have Been the Decision-Makers About Their Son’s Best Interests.Raanan Gillon - 2018 - Journal of Medical Ethics 44 (7):462-465.
    This paper argues that Charlie Gard’s parents should have been the decision-makers about their son’s best interests and that determination of Charlie’s best interests depended on a moral decision about which horn of a profound moral dilemma to choose. Charlie’s parents chose one horn of that moral dilemma and the courts, like Charlie Gard’s doctors, chose the other horn. Contrary to the first UK court’s assertion, supported by all the higher courts that considered it, that its judgement was ‘objective’, this (...)
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  60.  4
    Voices of Moral Authority: Parents, Doctors and What Will Actually Help.Richard David William Hain - 2018 - Journal of Medical Ethics 44 (7):458-461.
    The public often believes that parents have a right to make medical decisions about their child. The idea that, in respect of children, doctors should do what parents tell them to do is problematic on the face of it. The effect of such a claim would be that a doctor who acted deliberately to harm a child would be making a morally correct decision, providing only that it is what the child’s parents said they wanted. That is so obviously nonsense (...)
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  61.  2
    The Job of ‘Ethics Committees’ Should Be Ethically Informed Code Consistency Review.Søren Holm - 2018 - Journal of Medical Ethics 44 (7):488-488.
    Moore and Donnelly argue in the paper ‘The job of “ethics committees”’ that research ethics committees should be renamed and that their job should be specified as “review of proposals for consistency with the duly established and applicable code” only.1 They raise a large number of issues, but in this comment I briefly want to suggest that two of their arguments are fundamentally flawed. The first flawed argument is the argument related to the separation of powers. Moore and Donnelly proceed (...)
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  62. Clinic, Courtroom or Committee: In the Best Interests of the Critically Ill Child?Richard Huxtable - 2018 - Journal of Medical Ethics 44 (7):471-475.
    Law’s processes are likely always to be needed when particularly intractable conflicts arise in relation to the care of a critically ill child like Charlie Gard. Recourse to law has its merits, but it also imposes costs, and the courts’ decisions about the best interests of such children appear to suffer from uncertainty, unpredictability and insufficiency. The insufficiency arises from the courts’ apparent reluctance to enter into the ethical dimensions of such cases. Presuming that such reflection is warranted, this article (...)
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  63.  1
    Left of Bang Interventions in Trauma: Some Legal Implications of Military Medical Prophylaxis.Rain Liivoja - 2018 - Journal of Medical Ethics 44 (7):509-510.
    In the context of military medical care, Eisenstein and colleagues have introduced the notion ‘left of bang intervention in trauma’, which refers to interventions administered before trauma to reduce morbidity and mortality after injury. This paper responds to Eisenstein and colleagues’ ethical analysis of such interventions, highlighting the difficulty in distinguishing between purely prophylactic and enhancing interventions. This response also addresses legal issues that arise from left of bang interventions under human rights law and the law of armed conflict, in (...)
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  64.  2
    The ‘Ethics Committee’ Job is Administrative: A Response to Commentaries.Andrew John Moore - 2018 - Journal of Medical Ethics 44 (7):495-496.
    What job should authorities give to review boards? We are grateful to Soren Holm, Rosamond Rhodes, Julian Savulescu and G Owen Schaefer for their thoughtful commentaries on our answer.1–4 Here we add to the discussion. Let us summarise the claims for which we argued.5 Relevant authorities can task boards with review for consistency with duly established code, thereby making code-consistent activities apt for approval and code-inconsistent activities apt for rejection. They can instead task boards with review for ethical acceptability, making (...)
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  65.  7
    The Job of ‘Ethics Committees’.Andrew Moore & Andrew Donnelly - 2018 - Journal of Medical Ethics 44 (7):481-487.
    What should authorities establish as the job of ethics committees and review boards? Two answers are: review of proposals for consistency with the duly established and applicable code and review of proposals for ethical acceptability. The present paper argues that these two jobs come apart in principle and in practice. On grounds of practicality, publicity and separation of powers, it argues that the relevant authorities do better to establish code-consistency review and not ethics-consistency review. It also rebuts bad code and (...)
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  66.  1
    Approaches to Parental Demand for Non-Established Medical Treatment: Reflections on the Charlie Gard Case.John J. Paris, Brian M. Cummings, Michael P. Moreland & Jason N. Batten - 2018 - Journal of Medical Ethics 44 (7):443-447.
    The opinion of Mr. Justice Francis of the English High Court which denied the parents of Charlie Gard, who had been born with an extremely rare mutation of a genetic disease, the right to take their child to the United States for a proposed experimental treatment occasioned world wide attention including that of the Pope, President Trump, and the US Congress. The case raise anew a debate as old as the foundation of Western medicine on who should decide and on (...)
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  67.  1
    Guest Editorial: Charlie Gard’s Five Months in Court: Better Dispute Resolution Mechanisms for Medical Futility Disputes.Thaddeus Mason Pope - 2018 - Journal of Medical Ethics 44 (7):436-437.
    British courts have adjudicated dozens of medical futility disputes over the past 10 years. Many of these cases have involved pediatric patients. All these judgements are publicly available in searchable legal reporters. And most were covered by the print or broadcast media.1 Yet, as noted by Dressler, none of these earlier cases received even a fraction of the public or scholarly attention that Charlie Gard has received. One might assess the Gard case from two different perspectives. At one level, the (...)
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  68.  1
    The Goodness of Ethics in Research Ethics Review.Rosamond Rhodes - 2018 - Journal of Medical Ethics 44 (7):489-490.
    In their article, “The job of ‘ethics committees’”, Andrew Moore and Andrew Donnelly argue that current guidance documents provide that institutional research review committees ) perform two different and distinct functions, namely, a regulative review and an ethical review. They argue for separating those functions and for eliminating the ethics review role from IRBs. Instead, they want IRBs to focus exclusively on determining whether research proposals conform to governing regulations. In their argument, Moore and Donnelly correctly note that regulatory requirements (...)
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  69.  5
    The Structure of Ethics Review: Expert Ethics Committees and the Challenge of Voluntary Research Euthanasia.Julian Savulescu - 2018 - Journal of Medical Ethics 44 (7):491-493.
    In 2002, I wrote an editorial in this Journal arguing that it was time to review the structure and function of ethics committees in the USA, Australia and the UK.1 This followed the deaths of Ellen Roche and Jesse Gelsinger, which were at least in significant part due to the poor functioning of research ethics committees in the USA.2 In the case of Ellen Roche, it was the failure to require a systematic review of the existing literature which led to (...)
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  70.  10
    Philosophical Medical Ethics: More Necessary Than Ever.Julian Savulescu, Thomas Douglas & Dominic Wilkinson - 2018 - Journal of Medical Ethics 44 (7):434-435.
    When we applied for the editorship of the JME 7 years ago, we said that we considered the JME to be the most important journal in medicine. The most profound questions that health professionals face are not scientific or technical, but ethical. Our enormous scientific and medical progress already outstrips our capability to provide treatment. Life can be prolonged at enormous cost, sometimes far beyond the point that the individual appears to be gaining a net benefit from that life. Science (...)
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  71.  22
    Code-Consistent Ethics Review: Defence of a Hybrid Account.G. Owen Schaefer - 2018 - Journal of Medical Ethics 44 (7):494-495.
    It is generally unquestioned that human subjects research review boards should assess the ethical acceptability of protocols. It says so right on the tin, after all: they are explicitly called research ethics committees in the UK. But it is precisely those sorts of unchallenged assumptions that should, from time to time, be assessed and critiqued, in case they are in fact unfounded. John Stuart Mill's objection to suppressers of dissent is instructive here: “If the opinion is right, they are deprived (...)
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  72.  4
    Advancing Independent Adolescent Consent for Participation in HIV Prevention Research.Seema K. Shah, Susannah M. Allison, Bill G. Kapogiannis, Roberta Black, Liza Dawson & Emily Erbelding - 2018 - Journal of Medical Ethics 44 (7):431-433.
    In many regions around the world, those at highest risk for acquiring HIV are young adults and adolescents. Young men who have sex with men in the USA are the group at greatest risk for HIV acquisition, particularly if they are part of a racial or ethnic minority group.1 Adolescent girls and young women have the highest incidence rates of any demographic subgroup in sub-Saharan Africa.2 To reverse the global AIDS pandemic’s toll on these high-risk groups, it is important to (...)
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  73.  31
    Hard Lessons: Learning From the Charlie Gard Case.Dominic Wilkinson & Julian Savulescu - 2018 - Journal of Medical Ethics 44 (7):438-442.
    On 24 July 2017, the long-running, deeply tragic and emotionally fraught case of Charlie Gard reached its sad conclusion. Following further medical assessment of the infant, Charlie’s parents and doctors finally reached agreement that continuing medical treatment was not in Charlie’s best interests. Life support was subsequently withdrawn and Charlie died on 28 July 2017.Box 1 ### Case summary and timeline21–23 Charlie Gard was born at full term, apparently healthy, in August 2016. At a few weeks of age his parents (...)
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  74.  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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  75.  64
    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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  76. 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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  77.  1
    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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  78.  2
    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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  79.  2
    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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  80.  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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  81.  3
    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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  82.  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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  83.  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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  84.  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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  85.  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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  86.  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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  87.  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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  88.  7
    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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  89.  3
    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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  90.  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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  91.  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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  92.  5
    ‘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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  93.  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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  94.  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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  95.  4
    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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  96.  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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  97.  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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  98.  7
    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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  99.  3
    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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  100.  5
    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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  101.  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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  102.  4
    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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  103.  2
    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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  104.  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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  105.  5
    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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  106.  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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  107.  15
    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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  108.  8
    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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  109.  4
    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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  110.  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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  111.  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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  112.  3
    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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  113.  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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  114.  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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  115.  3
    ‘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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  116.  5
    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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  117.  8
    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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  118.  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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  119.  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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  120.  15
    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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  121.  9
    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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  122.  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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  123.  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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  124.  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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  125.  5
    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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  126.  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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  127.  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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  128.  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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  129.  5
    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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  130.  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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  131.  10
    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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  132.  7
    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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  133.  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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  134.  3
    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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  135.  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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  136.  8
    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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  137.  5
    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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  138.  3
    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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  139.  28
    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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  140.  3
    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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  141.  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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  142.  12
    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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  143.  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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  144.  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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  145.  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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  146.  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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  147.  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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  148.  7
    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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  149.  22
    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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  150.  5
    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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  151.  3
    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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  152.  9
    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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  153.  8
    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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  154.  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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  155.  10
    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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  156.  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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  157.  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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  158.  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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  159.  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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  160.  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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  161.  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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  162.  9
    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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  163.  7
    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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