Year:

  1.  1
    Trial by Triad: Substituted Judgment, Mental Illness and the Right to Die.Jacob M. Appel - 2022 - Journal of Medical Ethics 48 (6):358-361.
    Substituted judgment has increasingly become the accepted standard for rendering decisions for incapacitated adults in the USA. A broad exception exists with regard to patients with diminished capacity secondary to depressive disorders, as such patients’ previous wishes are generally not honoured when seeking to turn down life-preserving care or pursue aid-in-dying. The result is that physicians often force involuntary treatment on patients with poor medical prognoses and/or low quality of life as a result of their depressive symptoms when similarly situated (...)
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  2.  1
    In Defence of Our Model for Just Healthcare Systems: Why an Explicit Philosophy is Needed in Addition to the Law, and How Scanlon Helps Derive Just Policies.Caitríona L. Cox & Zoë Fritz - 2022 - Journal of Medical Ethics 48 (6):416-418.
    In a recent response to our paper on developing a philosophical framework to guide the design and delivery of a just health service, Sarela raises several objections. We feel that although Sarela makes points which are worthy of discussion, his critique does not undermine either the need for, or the worth of, our proposed model. First, the law does not negate the need for ethics in determining just healthcare policy. Reliance on legal processes can drive inappropriate focus on ensuring policies (...)
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  3.  1
    Ethics Briefing.Martin Davies, Sophie Brannan, Veronica English, Caroline Ann Harrison, Carrie Reidinger & Julian C. Sheather - 2022 - Journal of Medical Ethics 48 (6):427-428.
    On 7 April 2022 – coinciding with World Health Day – the British Medical Association launched its new report, Health and human rights in the new world order.1 Written during the global upheaval triggered by the COVID-19 pandemic, and published just weeks after the Russian invasion of Ukraine, the report responds to a range of emerging and intensifying threats to health-related human rights globally. As the report establishes, human rights in health and healthcare matter because human suffering, and its relief, (...)
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  4.  1
    Beyond Individualisation: Towards a More Contextualised Understanding of Women’s Social Egg Freezing Experiences.Michiel De Proost, Gily Coene, Julie Nekkebroeck & Veerle Provoost - 2022 - Journal of Medical Ethics 48 (6):386-390.
    Recently, Petersen provided in this journal a critical discussion of individualisation arguments in the context of social egg freezing. This argument underlines the idea that it is morally problematic to use individual technological solutions to solve societal challenges that women face. So far, however, there is a lack of empirical data to contextualise his central normative claim that individualisation arguments are implausible. This article discusses an empirical study that supports a contextualised reading of the normative work of Petersen. Based on (...)
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  5.  2
    Who Commits the Unnaturalistic Fallacy?Kyle Ferguson - 2022 - Journal of Medical Ethics 48 (6):382-383.
    According to G E Moore,1 we commit the naturalistic fallacy when we infer ‘x is good’ from non-evaluative premises involving x such as ‘ x is pleasant’ or ‘ x is desired’. On Moore’s view, the mistake is to think that we can reduce moral goodness to anything else or explain it in any other terms. We cannot analyse ‘good’, Moore thought, because goodness is simple, non-natural and sui generis. If Moore were alive today, and if he were to ask (...)
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  6.  1
    Framework for Evaluation Research on Clinical Ethical Case Interventions: The Role of Ethics Consultants.Joschka Haltaufderheide, Stephan Nadolny, Jochen Vollmann & Jan Schildmann - 2022 - Journal of Medical Ethics 48 (6):401-406.
    Evaluation of clinical ethical case consultations has been discussed as an important research task in recent decades. A rigid framework of evaluation is essential to improve quality of consultations and, thus, quality of patient care. Different approaches to evaluate those services appropriately and to determine adequate empirical endpoints have been proposed. A key challenge is to provide an answer to the question as to which empirical endpoints—and for what reasons—should be considered when evaluating the quality of a service. In this (...)
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  7.  9
    What Money Can’T Buy: An Argument Against Paying People to Get Vaccinated.Nancy S. Jecker - 2022 - Journal of Medical Ethics 48 (6):362-366.
    This paper considers the proposal to pay people to get vaccinated against the SARS-CoV-2 virus. The first section introduces arguments against the proposal, including less intrusive alternatives, unequal effects on populations and economic conditions that render payment more difficult to refuse. The second section considers arguments favouring payment, including arguments appealing to health equity, consistency, being worth the cost, respect for autonomy, good citizenship, the ends justifying the means and the threat of mutant strains. The third section spotlights long-term and (...)
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  8.  4
    Wrong Question and the Wrong Standard of Proof.Marc Lipsitch - 2022 - Journal of Medical Ethics 48 (6):378-379.
    I have two concerns about Pugh et al ’s case that vaccine requirements without a natural immunity exception are unjustified.1 First, the scientific question they suggest must be answered to justify the policy is in my view the wrong one, or at least not the only relevant one. Second, the authors set up a standard for public health regulation that will be often unattainable, risking paralysis of public health authorities. Pugh et al suggest two legitimate bases for vaccine mandates: ‘the (...)
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  9. Legitimising Values.John McMillan - 2022 - Journal of Medical Ethics 48 (6):357-357.
    While apparently helpful concepts such as ”best interests“ appear to have the virtue of simplicity, they are really place holders for the communication, time and listening that’s required to understand what truly matters to patients and others involved in healthcare. When we know what matters to a patient, we can have confidence that we have a “legitimate” view of what’s important to them. Two papers in this issue of the Journal of Medical Ethics explore different ways in which values can (...)
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  10.  5
    Value Assessment Frameworks: Who is Valuing the Care in Healthcare?Jonathan Anthony Michaels - 2022 - Journal of Medical Ethics 48 (6):419-426.
    Many healthcare agencies are producing evidence-based guidance and policy that may determine the availability of particular healthcare products and procedures, effectively rationing aspects of healthcare. They claim legitimacy for their decisions through reference to evidence-based scientific method and the implementation of just decision-making procedures, often citing the criteria of ‘accountability for reasonableness’; publicity, relevance, challenge and revision, and regulation. Central to most decision methods are estimates of gains in quality-adjusted life-years, a measure that combines the length and quality of survival. (...)
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  11.  30
    Moral Status of the Fetus and the Permissibility of Abortion: A Contractarian Response to Thomson’s Violinist Thought Experiment.Matthew John Minehan - 2022 - Journal of Medical Ethics 48 (6):407-410.
    Judith Jarvis Thomson famously argued that abortion is permissible even if we accept that a fetus qualifies as a person and possesses a right to life. The current paper presents two arguments that undermine Thomson’s position. First, the paper sketches a contractarian argument that explores Thomson’s violinist thought experiment from behind a veil of ignorance, which suggests that if we had an equal likelihood of being an unwanted fetus and a pregnant woman, it would be rational for us to oppose (...)
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  12.  8
    The Unnaturalistic Fallacy: COVID-19 Vaccine Mandates Should Not Discriminate Against Natural Immunity.Jonathan Pugh, Julian Savulescu, Rebecca C. H. Brown & Dominic Wilkinson - 2022 - Journal of Medical Ethics 48 (6):371-377.
    COVID-19 vaccine requirements have generated significant debate. Here, we argue that, on the evidence available, such policies should have recognised proof of natural immunity as a sufficient basis for exemption to vaccination requirements. We begin by distinguishing our argument from two implausible claims about natural immunity: natural immunity is superior to ‘artificial’ vaccine-induced immunity simply because it is ‘natural’ and it is better to acquire immunity through natural infection than via vaccination. We then briefly survey the evidence base for the (...)
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  13. Abortion and the Veil of Ignorance: A Response to Minehan.Joona Räsänen - 2022 - Journal of Medical Ethics 48 (6):411-412.
    In a recent JME paper, Matthew John Minehan applies John Rawls’ veil of ignorance against Judith Thomson’s famous violinist argument for the permissibility of abortion. Minehan asks readers to ‘imagine that one morning you are back to back in bed with another person. One of you is conscious and the other unconscious. You do not know which one you are’. Since from this position of ignorance, you have an equal chance of being the unconscious violinist and the conscious person attached (...)
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  14.  6
    Should Healthcare Workers Be Prioritised During the COVID-19 Pandemic? A View From Madrid and New York.Diego Real de Asua & Joseph J. Fins - 2022 - Journal of Medical Ethics 48 (6):397-400.
    While COVID-19 has generated a massive burden of illness worldwide, healthcare workers have been disproportionately exposed to SARS-CoV-2 coronavirus infection. During the so-called ‘first wave’, infection rates among this population group have ranged between 10% and 20%, raising as high as one in every four COVID-19 patients in Spain at the peak of the crisis. Now that many countries are already dealing with new waves of COVID-19 cases, a potential competition between HCW and non-HCW patients for scarce resources can still (...)
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  15.  1
    No Right Answer: Officials Need Discretion on Whether to Allow Natural Immunity Exemptions.Dorit Reiss - 2022 - Journal of Medical Ethics 48 (6):380-381.
    In their thoughtful, nuanced and interesting discussion, Jonathan Pugh, Julian Savulescu, Rebecca Brown and Dom Wilkinson argued that officials should recognise proof of prior infection as a valid exemption from vaccination requirements.1 This commentary agrees with parts of their analysis, but argues that the case for the exemption is less clear than the authors suggest, and the better approach is to allow officials flexibility: an exemption for natural immunity may be appropriate or may not. In part, the disagreements may stem (...)
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  16.  2
    Rawlsian Justice in Healthcare: A Response to Cox and Fritz.Abeezar I. Sarela - 2022 - Journal of Medical Ethics 48 (6):413-415.
    Cox and Fritz state the central problem as the absence of a framework for healthcare policy decisions; but, they overlook the theoretical underpinnings of public law. In response, they propose a two-step procedure to guide fair decision-making. The first step relies on Thomas Scanlon’s ‘contractualism’ for stakeholders to consider whether, or not, they could reasonably reject policy proposals made by others; then in the second step, John Rawls’s principles of justice are applied to these proposals; a fair policy requires to (...)
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  17.  1
    Is the International Regulation of Medical Complicity with Torture Largely Window Dressing? The Case of Israel and the Lessons of a 12-Year Medical Ethical Appeal.Derek Summerfield - 2022 - Journal of Medical Ethics 48 (6):367-370.
    This is the account of an ongoing appeal initiated in 2009 by 725 doctors from 43 countries concerning medical complicity with torture in Israel. It has been underpinned by a voluminous and still accumulating evidence base from reputable international and regional human rights organisations, quoted below, and has spanned the terms of office of four World Medical Association presidencies and two UN special rapporteurs on torture. This campaign has been a litmus test of whether international medical codes regarding doctors and (...)
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  18.  6
    Developing a Competency Framework for Health Research Ethics Education and Training.Sean Tackett, Jeremy Sugarman, Chirk Jenn Ng, Adeeba Kamarulzaman & Joseph Ali - 2022 - Journal of Medical Ethics 48 (6):391-396.
    Health research ethics training programmes are being developed and implemented globally, often with a goal of increasing local capacity to assure ethical conduct in health-related research. Yet what it means for there to be sufficient HRE capacity is not well-defined, and there is currently no consensus on outcomes that HRE training programmes should collectively intend to achieve. Without defining the expected outcomes, meaningful evaluation of individual participants and programmes is challenging. In this article, we briefly describe the evolution of formal (...)
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  19. Vaccine Mandates Need a Clear Rationale to Identify Which Exemptions Are Appropriate.Bridget Williams - 2022 - Journal of Medical Ethics 48 (6):384-385.
    The rapid development and roll-out of COVID-19 vaccines has been a surprising success of the pandemic and has likely saved hundreds of thousands of lives. Although most people were eager to receive a vaccine, many jurisdictions introduced mandates to ensure rapid uptake in the population, especially among key workers including healthcare workers. In some instances, individuals who can prove they have recovered from COVID-19 have been exempt from vaccine mandates, but in other cases such exemptions have not been made. Pugh (...)
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  20.  7
    Genomic Privacy, Identity and Dignity.Shlomo Cohen & Ro'I. Zultan - 2022 - Journal of Medical Ethics 48 (5):317-322.
    Significant advancements towards a future of big data genomic medicine, associated with large-scale public dataset repositories, intensify dilemmas of genomic privacy. To resolve dilemmas adequately, we need to understand the relative force of the competing considerations that make them up. Attitudes towards genomic privacy are complex and not well understood; understanding is further complicated by the vague claim of ‘genetic exceptionalism’. In this paper, we distinguish between consequentialist and non-consequentialist privacy interests: while the former are concerned with harms secondary to (...)
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  21.  3
    Meta-Surrogate Decision Making and Artificial Intelligence.Brian D. Earp - 2022 - Journal of Medical Ethics 48 (5):287-289.
    How shall we decide for others who cannot decide for themselves? And who—or what, in the case of artificial intelligence — should make the decision? The present issue of the journal tackles several interrelated topics, many of them having to do with surrogate decision making. For example, the feature article by Jardas et al 1 explores the potential use of artificial intelligence to predict incapacitated patients’ likely treatment preferences based on their sociodemographic characteristics, raising questions about the means by which (...)
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  22. Why the Term ‘Persistent Therapy’ is Not Worse Than the Term ‘Medical Futility’.Marcin Paweł Ferdynus - 2022 - Journal of Medical Ethics 48 (5):350-352.
    The discussion around the use of the term ‘medical futility’ began in the late 1980s. The Polish Working Group on End-of-Life Ethics joined this discussion in 2008. They offered their own approach to the issues regarding medical futility based on the category of persistent therapy. According to the PWG, ‘persistent therapy is the use of medical procedures to maintain the life function of the terminally ill in a way that prolongs their dying, introducing excessive suffering or violating their dignity’. In (...)
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  23.  9
    Autonomy, Identity and Health: Defining Quality of Life in Older Age.Sara Kate Heide - 2022 - Journal of Medical Ethics 48 (5):353-356.
    Defining quality of life is a difficult task as it is a subjective and personal experience. However, for the elderly, this definition is necessary for making complicated healthcare-related decisions. Commonly these decisions compare independence against safety or longevity against comfort. These choices are often not made in isolation, but with the help of a healthcare team. When the patient’s concept of quality of life is miscommunicated, there is a risk of harm to the patient whose best interests are not well (...)
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  24.  1
    Surrogate Decision Making in Crisis.Bianca Jackson, Kirsty Horsey & Andrew Spearman - 2022 - Journal of Medical Ethics 48 (5):297-298.
    The case states that a male same-sex couple entered into a surrogacy arrangement with an unrelated surrogate using donor sperm and the surrogate’s eggs. M is the legal mother pursuant to s33 of the Human Fertilisation and Embryology Act 2008. Though the facts tell us that there was no legally binding arrangement, this is in fact the position of the law: under s1A Surrogacy Arrangements Act, no surrogacy arrangements can ever be binding on the parties. It is not clear whether (...)
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  25.  1
    Autonomy-Based Criticisms of the Patient Preference Predictor.E. J. Jardas, David Wasserman & David Wendler - 2022 - Journal of Medical Ethics 48 (5):304-310.
    The patient preference predictor is a proposed computer-based algorithm that would predict the treatment preferences of decisionally incapacitated patients. Incorporation of a PPP into the decision-making process has the potential to improve implementation of the substituted judgement standard by providing more accurate predictions of patients’ treatment preferences than reliance on surrogates alone. Yet, critics argue that methods for making treatment decisions for incapacitated patients should be judged on a number of factors beyond simply providing them with the treatments they would (...)
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  26.  3
    Nursing Commentary to “Surrogate Decision-Making in Crisis”.Alice Bernadette Kavati & Fritzie Ramirez - 2022 - Journal of Medical Ethics 48 (5):293-294.
    The neonatal nurse forges a unique partnership with parents of a critically ill infant who are often, unexpectedly, exposed to the bewildering and complex environment that is neonatal intensive care, helping navigate them through this unchartered territory. Our role is multifaceted, with the primary focus of providing care in the best interests of our patients.1 This is realised through the provision of high-quality evidence-based care, advocating for the needs of the baby and family, and when required acting as a linchpin (...)
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  27.  7
    Animal Researchers Shoulder a Psychological Burden That Animal Ethics Committees Ought to Address.Mike King & Hazem Zohny - 2022 - Journal of Medical Ethics 48 (5):299-303.
    Animal ethics committees typically focus on the welfare of animals used in experiments, neglecting the potential welfare impact of that animal use on the animal laboratory personnel. Some of this work, particularly the killing of animals, can impose significant psychological burdens that can diminish the well-being of laboratory animal personnel, as well as their capacity to care for animals. We propose that AECs, which regulate animal research in part on the basis of reducing harm, can and ought to require that (...)
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  28.  3
    What Can Data Trusts for Health Research Learn From Participatory Governance in Biobanks?Richard Milne, Annie Sorbie & Mary Dixon-Woods - 2022 - Journal of Medical Ethics 48 (5):323-328.
    New models of data governance for health data are a focus of growing interest in an era of challenge to the social licence. In this article, we reflect on what the data trust model, which is founded on principles of participatory governance, can learn from experiences of involving and engagement of members of the public and participants in the governance of large-scale biobanks. We distinguish between upstream and ongoing governance models, showing how they require careful design and operation if they (...)
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  29.  2
    Commentary on ‘Autonomy-Based Criticisms of the Patient Preference Predictor’.Collin O'Neil - 2022 - Journal of Medical Ethics 48 (5):315-316.
    When a patient lacks sufficient capacity to make a certain treatment decision, whether because of deficits in their ability to make a judgement that reflects their values or to make a decision that reflects their judgement or both, the decision must be made by a surrogate. Often the best way to respect the patient’s autonomy, in such cases, is for the surrogate to make a ‘substituted’ judgement on behalf of the patient, which is the decision that best reflects the patient’s (...)
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  30.  1
    Self-Reported Physician Attitudes and Behaviours Towards Incarcerated Patients.Kevin Pierre, Kiarash P. Rahmanian, Benjamin J. Rooks & Lauren B. Solberg - 2022 - Journal of Medical Ethics 48 (5):338-342.
    Physicians anecdotally report inquiring about incarcerated patients’ crimes and their length of sentence, which has potential implications for the quality of care these patients receive. However, there is minimal research on how a physician’s awareness of their patient’s crimes/length of sentence impacts physician behaviours and attitudes. We performed regression modelling on a 27-question survey to analyse physician attitudes and behaviours towards incarcerated patients. We found that, although most physicians did not usually try to learn of their patients’ crimes, they often (...)
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  31.  4
    Commentary to ‘Surrogate Decision Making in Crisis’.Thillagavathie Pillay, Mona Noureldein, Manjit Kagla, Tracey Vanner & Deevena Chintala - 2022 - Journal of Medical Ethics 48 (5):291-292.
    As clinicians, this case1 raises both personal and professional challenges. A key issue is who carries legal parental responsibility for the difficult decisions that may be required around life-sustaining care in baby T. Medicolegally, we understand that the surrogate mother holds legal parental responsibility for baby T until this can be transferred to the intended parents.2 But this process can take many months to complete, after the birth of baby. As M is now critically ill and unable to engage in (...)
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  32.  10
    Sense and Sensitivity: Can an Inaccurate Test Be Better Than No Test at All?Jonathan Pugh, Dominic Wilkinson & Julian Savulescu - 2022 - Journal of Medical Ethics 48 (5):329-333.
    The UK government has put lateral flow antigen tests at the forefront of its strategy to scale-up testing in the coronavirus pandemic. However, evidence from a pilot trial using an LFAT to identify asymptomatic infections in the community suggested that the test missed over half of the positive cases in the tested population. This raises the question of whether it can be ethical to use an inaccurate test to guide public health measures. We begin by explicating different dimensions of test (...)
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  33.  9
    Environmental Sustainability and the Carbon Emissions of Pharmaceuticals.Cristina Richie - 2022 - Journal of Medical Ethics 48 (5):334-337.
    The US healthcare industry emits an estimated 479 million tonnes of carbon dioxide each year; nearly 8% of the country’s total emissions. When assessed by sector, hospital care, clinical services, medical structures, and pharmaceuticals are the top emitters. For 15 years, research has been dedicated to the medical structures and equipment that contribute to carbon emissions. More recently, hospital care and clinical services have been examined. However, the carbon of pharmaceuticals is understudied. This article will focus on the carbon emissions (...)
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  34.  7
    Sovereignty, Authenticity and the Patient Preference Predictor.Ben Schwan - 2022 - Journal of Medical Ethics 48 (5):311-312.
    The question of how to treat an incapacitated patient is vexed, both normatively and practically—normatively, because it is not obvious what the relevant objectives are; practically, because even once the relevant objectives are set, it is often difficult to determine which treatment option is best given those objectives. But despite these complications, here is one consideration that is clearly relevant: what a patient prefers. And so any device that could reliably identify a patient’s preferences would be a promising tool for (...)
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  35.  7
    Autonomy, Shared Agency and Prediction.Sungwoo Um - 2022 - Journal of Medical Ethics 48 (5):313-314.
    The patient preference predictor is a computer-based algorithm devised to predict the medical treatment that decisionally incapacitated patients would have preferred. The target paper argues against various criticisms to the effect that the use of a PPP is inconsistent with proper respect for patient autonomy.1 In this commentary, I aim to add some clarifications to the complex relationship between autonomy and the PPP. First, I highlight one way in which the decision of a surrogate designated by the patient realises respect (...)
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  36. Surrogate Uncertainty: Who Decides?Dominic Wilkinson - 2022 - Journal of Medical Ethics 48 (5):295-296.
    In the case that triggered this round-table discussion there are three separate factors that contribute to moral uncertainty.1 First, the infant, baby T, is extremely premature with suspected brain injury and potentially poor prognosis. Second, the gestational mother is critically unwell herself and her outlook is guarded. Third, as linked commentaries make clear, the legal status of the intended parents is complex and ambiguous.2 3 Any of these factors on their own would be enough to generate ethical complexity and distress (...)
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  37.  6
    Surrogate Decision Making in Crisis.Dominic Wilkinson & Thillagavathie Pillay - 2022 - Journal of Medical Ethics 48 (5):290-290.
    Care of the critically ill newborn includes support for the birth mother/parents with regular updates around the clinical condition of the baby, and involvement in discussions around complex decision-making issues. Discussions around continuation or discontinuation of life-sustaining are challenging even in the most straightforward of cases, but what happens when the birth mother is critically unwell? Such cases can lead to uncertainty around who should assume the parental role for these difficult discussions. In this round table discussion, we explore the (...)
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  38.  2
    Moral Obligations in Conducting Stem Cell-Based Therapy Trials for Autism Spectrum Disorder.Nicole Shu Ling Yeo-Teh & Bor Luen Tang - 2022 - Journal of Medical Ethics 48 (5):343-348.
    Unregulated patient treatments and approved clinical trials have been conducted with haematopoietic stem cells and mesenchymal stem cells for children with autism spectrum disorder. While the former direct-to-consumer practice is usually considered rogue and should be legally constrained, regulated clinical trials could also be ethically questionable. Here, we outline principal objections against these trials as they are currently conducted. Notably, these often lack a clear rationale for how transplanted cells may confer a therapeutic benefit in ASD, and thus, have ill-defined (...)
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  39.  2
    ‘Who is Going to Put Their Life on the Line for a Dollar? That’s Crazy’: Community Perspectives of Financial Compensation in Clinical Research.Amie Devlin, Kirsten Brownstein, Jennifer Goodwin, Emily Gibeau, Mariana Pardes, Heidi Grunwald & Susan Fisher - 2022 - Journal of Medical Ethics 48 (4):261-265.
    BackgroundFinancial compensation of research participants has been standard practice for centuries, however, there is an ongoing debate among researchers and ethicists regarding the ethical nature of this practice. While these debates develop ethical arguments and theories, they fail to incorporate input from those most affected by financial compensation: potential research participants.MethodsTo identify attitudes surrounding clinical research, participants of a long-standing cohort completed a one-time interview. Open-ended questions stimulated a participant-driven discussion surrounding medical research. Following a grounded theory methodology, 58 semistructured (...)
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  40.  6
    When the Frameworks Don’T Work: Data Protection, Trust and Artificial Intelligence.Zoë Fritz - 2022 - Journal of Medical Ethics 48 (4):213-214.
    With new technologies come new ethical challenges. Often, we can apply previously established principles, even though it may take some time to fully understand the detail of the new technology - or the questions that arise from it. The International Commission on Radiological Protection, for example, was founded in 1928 and has based its advice on balancing the radiation exposure associated with X-rays and CT scans with the diagnostic benefits of the new investigations. They have regularly updated their advice as (...)
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  41.  4
    Hospital Chaplains as Ethical Consultants in Making Difficult Medical Decisions.Waldemar Głusiec - 2022 - Journal of Medical Ethics 48 (4):256-260.
    Background and aimsFew Polish hospitals have Hospital Ethics Committee and the services are not always adequate. In this situation, the role of HECs, in providing, among others, ethical advice on the discontinuation of persistent therapies, may be taken over by other entities. The aim of our research was to investigate, how often and on what issues hospital chaplains are asked for ethical advice in reaching difficult medical decisions.MethodsA survey of 100 Roman Catholic chaplains was conducted, that is, at least 10% (...)
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  42.  3
    Agree to Disagree: The Symmetry of Burden of Proof in Human–AI Collaboration.Karin Rolanda Jongsma & Martin Sand - 2022 - Journal of Medical Ethics 48 (4):230-231.
    In their paper ‘Responsibility, second opinions and peer-disagreement: ethical and epistemological challenges of using AI in clinical diagnostic contexts’, Kempt and Nagel discuss the use of medical AI systems and the resulting need for second opinions by human physicians, when physicians and AI disagree, which they call the rule of disagreement.1 The authors defend RoD based on three premises: First, they argue that in cases of disagreement in medical practice, there is an increased burden of proof for the physician in (...)
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  43.  2
    Taking the Burden Off: A Study of the Quality of Ethics Consultation in the Time of COVID-19.Lulia Kana, Andrew Shuman, Raymond De Vries & Janice Firn - 2022 - Journal of Medical Ethics 48 (4):244-249.
    BackgroundThe quality of ethics consults is notoriously difficult to measure. Survey-based assessments cannot capture nuances of consultations. To address this gap, we conducted interviews with health professionals who requested ethics consults during the initial phase of the COVID-19 pandemic.MethodHealthcare professionals requesting ethics consultation between March 2020 and May 2020 at a tertiary academic medical centre were eligible to participate. We asked participants to comment on the consults they called and thematically analysed responses to identify features associated with optimal quality consultations.ResultsOf (...)
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  44.  4
    Responsibility, Second Opinions and Peer-Disagreement: Ethical and Epistemological Challenges of Using AI in Clinical Diagnostic Contexts.Hendrik Kempt & Saskia K. Nagel - 2022 - Journal of Medical Ethics 48 (4):222-229.
    In this paper, we first classify different types of second opinions and evaluate the ethical and epistemological implications of providing those in a clinical context. Second, we discuss the issue of how artificial intelligent could replace the human cognitive labour of providing such second opinion and find that several AI reach the levels of accuracy and efficiency needed to clarify their use an urgent ethical issue. Third, we outline the normative conditions of how AI may be used as second opinion (...)
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  45.  1
    Are Physicians Requesting a Second Opinion Really Engaging in a Reason-Giving Dialectic? Normative Questions on the Standards for Second Opinions and AI.Benjamin H. Lang - 2022 - Journal of Medical Ethics 48 (4):234-235.
    In their article, ‘Responsibility, Second Opinions, and Peer-Disagreement—Ethical and Epistemological Challenges of Using AI in Clinical Diagnostic Contexts,’ Kempt and Nagel argue for a ‘rule of disagreement’ for the integration of diagnostic AI in healthcare contexts. The type of AI in question is a ‘decision support system’, the purpose of which is to augment human judgement and decision-making in the clinical context by automating or supplementing parts of the cognitive labor. Under the authors’ proposal, artificial decision support systems which produce (...)
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  46.  3
    Age—Not Sex or Gender—Makes the Case of Ellie Anderson Complex.Elizabeth Lanphier & Shannon Fyfe - 2022 - Journal of Medical Ethics 48 (4):266-267.
    In ‘The Complex Case of Ellie Anderson’, Joona Rasanen and Anna Smajdor raise several ethical questions about the case. One question asks, but does not answer, whether Ellie faced discrimination for being transgender when her mother was not allowed access to Ellie’s sperm following her death. In raising the question, the authors imply anti-trans bias may have influenced this determination. However, this inference is not supported by current ethical and legal guidance for posthumous use of gametes, with which Ellie’s case (...)
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  47.  7
    Philosophical Evaluation of the Conceptualisation of Trust in the NHS’ Code of Conduct for Artificial Intelligence-Driven Technology.Soogeun Samuel Lee - 2022 - Journal of Medical Ethics 48 (4):272-277.
    The UK Government’s Code of Conduct for data-driven health and care technologies, specifically artificial intelligence -driven technologies, comprises 10 principles that outline a gold-standard of ethical conduct for AI developers and implementers within the National Health Service. Considering the importance of trust in medicine, in this essay I aim to evaluate the conceptualisation of trust within this piece of ethical governance. I examine the Code of Conduct, specifically Principle 7, and extract two positions: a principle of rationally justified trust that (...)
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  48.  8
    AI Decision-Support: A Dystopian Future of Machine Paternalism?David D. Luxton - 2022 - Journal of Medical Ethics 48 (4):232-233.
    Physicians and other healthcare professionals are increasingly finding ways to use artificial intelligent decision support systems in their work. IBM Watson Health, for example, is a commercially available technology that is providing AI-DDS services in genomics, oncology, healthcare management and more.1 AI’s ability to scan massive amounts of data, detect patterns, and derive solutions from data is vastly more superior than that of humans. AI technology is undeniably integral to the future of healthcare and public health, and thoughtful consideration of (...)
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  49.  16
    Pandemic Prioritarianism.Lasse Nielsen - 2022 - Journal of Medical Ethics 48 (4):236-239.
    Prioritarianism pertains to the generic idea that it matters more to benefit people, the worse off they are, and while prioritarianism is not uncontroversial, it is considered a generally plausible and widely shared distributive principle often applied to healthcare prioritisation. In this paper, I identify social justice prioritarianism, severity prioritarianism and age-weighted prioritarianism as three different interpretations of the general prioritarian idea and discuss them in light of the effect of pandemic consequences on healthcare priority setting. On this analysis, the (...)
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  50.  5
    Canadian Perspective on Ageism and Selective Lockdown: A Response to Savulescu and Cameron.Hayden P. Nix - 2022 - Journal of Medical Ethics 48 (4):268-269.
    In a recent article, ‘Why lockdown of the elderly is not ageist and why levelling down equality is wrong’, Savulescu and Cameron argue that a selective lockdown of older people is not ageist because it would treat people unequally based on morally relevant differences. This response argues that a selective lockdown of older people living in long-term care homes would be unjust because it would allow the expansive liberties of the general public to undermine the basic liberties of older people, (...)
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  51.  1
    Ethics Briefing.Dominic Norcliffe-Brown, Sophie Brannan, Martin Davies, Veronica English, Caroline Ann Harrison & Julian C. Sheather - 2022 - Journal of Medical Ethics 48 (4):285-286.
    In parts of the world, discussion regarding COVID-19 has shifted towards endemicity, and questions of living with, rather than directly battling, the virus. As a result, ethical questions are being refocussed. The imperative is beginning to shift towards what we can learn from the pandemic, and how we can better prepare for future global outbreaks. Among the questions that need to be addressed is what Covid-29 has taught us about how research can be conducted ethically during major global public health (...)
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  52. Balancing Rules in Postmortem Sperm Donation.Guido Pennings - 2022 - Journal of Medical Ethics 48 (4):270-271.
    Postmortem sperm donation implies the acceptance of a very low sperm quality threshold. This threshold has two important consequences: recipients will have to submit to burdensome and expensive in vitro fertilisation/intracytoplasmic sperm injection, and many more living donors will be accepted, thus making postmortem donors largely superfluous. Given these strong arguments against the use of postmortem collected sperm, a good alternative to enlarge the donor pool would be men who stored sperm for self-use and no longer have the intention to (...)
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  53. The Complex Case of Ellie Anderson.Joona Räsänen & Anna Smajdor - 2022 - Journal of Medical Ethics 48 (4):217-221.
    Ellie Anderson had always known that she wanted to have children. Her mother, Louise, was aware of this wish. Ellie was designated male at birth, but according to news sources, identified as a girl from the age of three. She was hoping to undergo gender reassignment surgery at 18, but died unexpectedly at only 16, leaving Louise grappling not only with the grief of losing her daughter, but with a complex legal problem. Ellie had had her sperm frozen before starting (...)
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  54.  1
    Ethical Issues in Computational Pathology.Tom Sorell, Nasir Rajpoot & Clare Verrill - 2022 - Journal of Medical Ethics 48 (4):278-284.
    This paper explores ethical issues raised by whole slide image-based computational pathology. After briefly giving examples drawn from some recent literature of advances in this field, we consider some ethical problems it might be thought to pose. These arise from the tension between artificial intelligence research—with its hunger for more and more data—and the default preference in data ethics and data protection law for the minimisation of personal data collection and processing; the fact that computational pathology lends itself to kinds (...)
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  55.  3
    Personal Perspectives: Having the Time to Observe the Patient.Simon D. Taylor-Robinson - 2022 - Journal of Medical Ethics 48 (4):215-216.
    Being a medically qualified patient can be an unpleasant experience for a person who is used to making decisions. For the most part, this applies to the vast majority of doctors and other healthcare professionals. Becoming passive and surrendering the decision-making process to others is alien to the medical culture we were taught. However, when as a hospitalised medically qualified patient, one sees fellow patients in difficulty, or deteriorating clinically, unnoticed by medical staff, the question of whether it is ethical (...)
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  56.  9
    Vaccine Confidence, Public Understanding and Probity: Time for a Shift in Focus?Ana Wheelock & Jonathan Ives - 2022 - Journal of Medical Ethics 48 (4):250-255.
    Lack of vaccine confidence can contribute to drops in vaccination coverage and subsequent outbreaks of diseases like measles and polio. Low trust in vaccines is attributed to a combination of factors, including lack of understanding, vaccine scares, flawed policies, social media and mistrust of vaccine manufacturers, scientists and decision-makers. The COVID-19 crisis has laid bare societies’ vulnerability to new pathogens and the critical role of vaccines in containing this and future pandemics. It has also put science at the forefront of (...)
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  57.  14
    AI Support for Ethical Decision-Making Around Resuscitation: Proceed with Care.Nikola Biller-Andorno, Andrea Ferrario, Susanne Joebges, Tanja Krones, Federico Massini, Phyllis Barth, Georgios Arampatzis & Michael Krauthammer - 2022 - Journal of Medical Ethics 48 (3):175-183.
    Artificial intelligence systems are increasingly being used in healthcare, thanks to the high level of performance that these systems have proven to deliver. So far, clinical applications have focused on diagnosis and on prediction of outcomes. It is less clear in what way AI can or should support complex clinical decisions that crucially depend on patient preferences. In this paper, we focus on the ethical questions arising from the design, development and deployment of AI systems to support decision-making around cardiopulmonary (...)
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  58.  3
    Dividing Line Between Organ Donation and Euthanasia in a Combined Procedure.Jan Bollen, Kris Vissers & Walther van Mook - 2022 - Journal of Medical Ethics 48 (3):196-197.
    In this article, we want to reply to the recent article by Buturovic, to be able to correct some statements and allegations about this combined procedure. Organ donation after euthanasia is an extremely difficult procedure from an ethical point of view. On the one hand, we see a suffering patient who wants to die but who also wants to make an altruistic effort to donate his organs. On the other hand, we visualise a patient in need of an organ but (...)
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  59.  8
    Can We Know If Donor Trust Expires? About Trust Relationships and Time in the Context of Open Consent for Future Data Use.Felix Gille & Caroline Brall - 2022 - Journal of Medical Ethics 48 (3):184-188.
    As donor trust legitimises research, trust is vital for research in the fields of biomedicine, genetics, translational medicine and personalised medicine. For parts of the donor community, the consent signature is a sign of trust in research. Many consent processes in biomedical research ask donors to provide their data for an unspecified future use, which introduces uncertainty of the unknown. This uncertainty can jeopardise donor trust or demand blind trust. But which donor wants to trust blindly? To reduce this uncertainty, (...)
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  60.  1
    The Ethics of Disease-Modifying Drugs Targeting Alzheimer Disease: Response to Our Commentators.Erik Gustavsson, Pauline Raaschou, Gerd Lärfars, Lars Sandman & Niklas Juth - 2022 - Journal of Medical Ethics 48 (3):193-193.
    In Gustavsson et al,1 we discussed the ethical issues that arise when identifying the relevant population for disease-modifying drugs targeting Alzheimer disease. More specifically, we focused on novel immunotherapies aimed at amyloid β and tau, two relevant biomarkers. The commentaries to our paper2 3 acknowledge our conclusion: screening for AD involve ethical costs that cannot be justified unless a drug with clinically relevant effect becomes available. Since Aduhelm is the only immunotherapy targeting AD currently approved by the Food and Drug (...)
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  61.  4
    Duty of Candour and Communication During an Infection Control Incident in a Paediatric Ward of a Scottish Hospital: How Can We Do Better?Teresa Inkster & John Cuddihy - 2022 - Journal of Medical Ethics 48 (3):160-164.
    Duty of candour legislation was introduced in Scotland in 2018. However, literature and experience of duty of candour when applied to infection control incidents/outbreaks is scarce. We describe clinician and parental perspectives with regard to duty of candour and communication during a significant infection control incident in a haemato-oncology ward of a children’s hospital. Based on the learning from this incident, we make recommendations for duty of candour and communication to patients and families during future infection control incidents. These include (...)
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  62.  1
    Does Zero-COVID Neglect Health Disparities?Nancy S. Jecker & Derrick K. S. Au - 2022 - Journal of Medical Ethics 48 (3):169-172.
    Since the World Health Organization first declared the novel coronavirus a pandemic, diverse strategies have emerged to address it. This paper focuses on two leading strategies, elimination and mitigation, and examines their ethical basis. Elimination or ‘Zero-COVID’ dominates policies in Pacific Rim societies. It sets as a goal zero deaths and seeks to contain transmission using stringent short-term lockdowns, followed by strict find, test, trace and isolate methods. Mitigation, which dominates in the US and most European nations, sets targets for (...)
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  63.  5
    High Ideals: The Misappropriation and Reappropriation of the Heroic Label in the Midst of a Global Pandemic.Elaine L. Kinsella & Rachel C. Sumner - 2022 - Journal of Medical Ethics 48 (3):198-199.
    The purpose of this article is to offer an alternative, more nuanced analysis of the labelling of frontline workers as heroes than originally proposed. Here, we argue that the hero narrative in itself need not be problematic, but highlight a number of wider factors that have led to the initial rise in support for labelling frontline workers as heroes. Through our related work, we have gathered similar stories from frontline workers where they feel betrayed, let down or otherwise short-changed by (...)
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  64.  3
    Understanding Japan’s Response to the COVID-19 Pandemic.Satoshi Kodama, Michael Campbell, Miho Tanaka & Yusuke Inoue - 2022 - Journal of Medical Ethics 48 (3):173-173.
    Jecker and Au’s paper raises important issues concerning health equity in pandemic responses, and the importance of considering the long-term effects of pandemic strategy on population health and well-being.1 We welcome their focus on the experience of Asian countries, including Japan. However, we have some concerns with both the distinction which they draw between elimination and mitigation, and their account of the nature and origins of the Japanese response to the COVID-19 pandemic. First, we believe that the distinction between elimination (...)
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  65.  4
    Expanding Insurance Coverage for in Vitro Fertilisation with Preimplantation Genetic Testing: Putting the Cart Before the Horse.Emily C. Lisi - 2022 - Journal of Medical Ethics 48 (3):202-204.
    Madison Kilbride recently argued that insurance ) should cover in vitro fertilisation with preimplantation genetic testing services for couples at high risk of having a child affected with a genetic condition. She argues that IVF-PGT meets CMS’s definition of ‘medically necessary care’, where such care includes ‘services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms’. Kilbride argues that IVF-PGT satisfies this definition in two ways: as a diagnostic tool and as a treatment. Contradicting (...)
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  66.  1
    Trust and Medical Ethics.John McMillan - 2022 - Journal of Medical Ethics 48 (3):153-153.
    There will always be debates in medical ethics about whether any particular value can be considered foundational, but there are reasons for thinking that ‘trust’ is the ground upon which many other important values is built. Sisela Bok remarks: > If there is no confidence in the truthfulness of others, is there any way to assess their fairness, their intentions to help or to harm? How, then, can they be trusted? Whatever matters to human beings, trust is the atmosphere in (...)
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  67.  9
    ‘Value, Values and Valued’: A Tripod for Organisational Ethics.Raj Mohindra - 2022 - Journal of Medical Ethics 48 (3):154-159.
    Public benefit corporations are National Health Service, that is, state, entities whose function to provide healthcare in discharge of public duties. If we regard value as the output of such organisations, it seems logical to connect the values of the organisation to the value produced by such organisations. But, on closer examination there are competing underlying logics in play: those based on promoting organisational efficiency and efficacy; and those based on the idea of building service provision around the clinician–patient relationship. (...)
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  68.  8
    The Capacity to Designate a Surrogate is Distinct From Decisional Capacity: Normative and Empirical Considerations.Mark Navin, Jason Adam Wasserman, Devan Stahl & Tom Tomlinson - 2022 - Journal of Medical Ethics 48 (3):189-192.
    The capacity to designate a surrogate is not simply another kind of medical decision-making capacity. A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patients who lack DMC (...)
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  69.  5
    From Proband to Provider: Is There an Obligation to Inform Genetic Relatives of Actionable Risks Discovered Through Direct-to-Consumer Genetic Testing?Jordan A. Parsons & Philip E. Baker - 2022 - Journal of Medical Ethics 48 (3):205-212.
    Direct-to-consumer genetic testing is a growing phenomenon, fuelled by the notion that knowledge equals control. One ethical question that arises concerns the proband’s duty to share information indicating genetic risks in their relatives. However, such duties are unenforceable and may result in the realisation of anticipated harm to relatives. We argue for a shift in responsibility from proband to provider, placing a duty on test providers in the event of identified actionable risks to relatives. Starting from Parker and Lucassen’s 'joint (...)
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  70.  5
    Zero COVID and Health Inequities: Lessons From Singapore.G. Owen Schaefer - 2022 - Journal of Medical Ethics 48 (3):174-174.
    COVID-19 has stolen millions of lives and devastated livelihoods around the world and led to the exacerbation of existing inequities within and between countries. This part of a tragic pattern in catastrophes, where the most vulnerable populations are typically the ones to bear the greatest burdens. Jecker and Au1 offer a keen observation of how one particular COVID-19 response—Zero COVID—appears particularly problematic from a health equity perspective. Under Zero COVID, countries enact stringent lockdowns and movement restrictions in order to keep (...)
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  71.  19
    Future of Global Regulation of Human Genome Editing: A South African Perspective on the WHO Draft Governance Framework on Human Genome Editing.Bonginkosi Shozi, Tamanda Kamwendo, Julian Kinderlerer, Donrich W. Thaldar, Beverley Townsend & Marietjie Botes - 2022 - Journal of Medical Ethics 48 (3):165-168.
    WHO in 2019 established the Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing, which has recently published a Draft Governance Framework on Human Genome Editing. Although the Draft Framework is a good point of departure, there are four areas of concern: first, it does not sufficiently address issues related to establishing safety and efficacy. Second, issues that are a source of tension between global standard setting and state sovereignty need to be addressed in a (...)
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  72.  39
    Does Birth Matter?Walter Veit - 2022 - Journal of Medical Ethics 48 (3):194-195.
    This paper is a response to a recent paper by Bobier and Omelianchuk in which they argue that the critics of Giubilini and Minerva’s defence of infanticide fail to adequately justify a moral difference at birth. They argue that such arguments would lead to an intuitively less plausible position: that late-term abortions are permissible, thus creating a dilemma for those who seek to argue that birth matters. I argue that the only way to resolve this dilemma, is to bite the (...)
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  73.  10
    CRISPR Immunity: A Case Study for Justified Somatic Genetic Modification?Eli Y. Adashi & Ivan Glenn Cohen - 2022 - Journal of Medical Ethics 48 (2):83-85.
    The current SARS-CoV-2 pandemic has killed thousands across the world. SARS-CoV-2 is the latest but surely not the last such global pandemic we will face. The biomedical response to such pandemics includes treatment, vaccination, and so on. In this paper, though, we argue that it is time to consider an additional strategy: the somatic enhancement of human immunity. We argue for this approach and consider bioethics objections we believe can be overcome.
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  74.  3
    Twin Pregnancy Reduction is Not an ‘All or Nothing’ Problem: A Response to Räsänen.Dunja Begović, Elizabeth Chloe Romanis & E. J. Verweij - 2022 - Journal of Medical Ethics 48 (2):139-141.
    In his paper, ‘Twin pregnancy, fetal reduction and the ‘all or nothing problem’, Räsänen sets out to apply Horton’s ‘all or nothing’ problem to the ethics of multifetal pregnancy reduction from a twin to a singleton pregnancy. Horton’s problem involves the following scenario: imagine that two children are about to be crushed by a collapsing building. An observer would have three options: do nothing, save one child by allowing their arms to be crushed, or save both by allowing their arms (...)
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  75.  3
    Does NICE Apply the Rule of Rescue in its Approach to Highly Specialised Technologies?Victoria Charlton - 2022 - Journal of Medical Ethics 48 (2):118-125.
    The National Institute for Health and Care Excellence, the UK’s main healthcare priority-setting body, recently reaffirmed a longstanding claim that in recommending technologies to the National Health Service it cannot apply the ‘rule of rescue’. This paper explores this claim by identifying key characteristics of the rule and establishing to what extent these are also features of NICE’s approach to evaluating ultra-orphan drugs through its highly specialised technologies programme. It argues that although NICE in all likelihood does not act because (...)
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  76.  2
    Challenges of Economic Evaluation in Rare Diseases.Stephen Duckett - 2022 - Journal of Medical Ethics 48 (2):93-94.
    It is hard to argue with the proposition that value for money should guide health spending. However, even after decades of development, economic evaluation is still a work in progress. As applied, it deals poorly with issues of social justice, ageing and end of life issues; cases involving small numbers—such as decisions about orphan drugs—are also contested. Unfortunately, differences in incremental cost-effectiveness ratios are presented with a degree of precision which contributes to an ‘illusion of validity’.1 Nobel Laureate Amartya Sen (...)
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  77.  3
    Double Bad Luck: Should Rare Diseases Get Special Treatment?Adam Hutchings - 2022 - Journal of Medical Ethics 48 (2):99-100.
    In June 2021, an 1856 British Guiana 1c magenta stamp sold for US$8.3m. It is the only known specimen of its kind in existence and on a gram-for-gram basis the most valuable item in the world. Clearly, in some spheres of human engagement, rarity carries a premium. Should this logic be applied in healthcare? Magalhaes thinks not.1 They explore the topic of whether pricing and reimbursement systems should give a premium to orphan drugs for rare diseases. They argue that rarity (...)
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  78.  7
    Informed Consent and Compulsory Medical Device Registries: Ethics and Opportunities.Daniel B. Kramer & Efthimios Parasidis - 2022 - Journal of Medical Ethics 48 (2):79-82.
    Many high-risk medical devices earn US marketing approval based on limited premarket clinical evaluation that leaves important questions unanswered. Rigorous postmarket surveillance includes registries that actively collect and maintain information defined by individual patient exposures to particular devices. Several prominent registries for cardiovascular devices require enrolment as a condition of reimbursement for the implant procedure, without informed consent. In this article, we focus on whether these registries, separate from their legal requirements, have an ethical obligation to obtain informed consent from (...)
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  79.  2
    Should Rare Diseases Get Special Treatment?Monica Magalhaes - 2022 - Journal of Medical Ethics 48 (2):86-92.
    Orphan drug policy often gives ‘special treatment’ to rare diseases, by giving additional priority or making exceptions to specific drugs, based on the rarity of the conditions they aim to treat. This essay argues that the goal of orphan drug policy should be to make prevalence irrelevant to funding decisions. It aims to demonstrate that it is severity, not prevalence, which drives our judgments that important claims are being overlooked when treatments for severe rare diseases are not funded. It shows (...)
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  80.  6
    Unweighted Lotteries and Compounding Injustice: Reply to Schmidt Et Al.Alex James Miller Tate - 2022 - Journal of Medical Ethics 48 (2):131-132.
    I argue that Schmidt et al, while correctly diagnosing the serious racial inequity in current ventilator rationing procedures, misidentify a corresponding racial inequity issue in alternative ‘unweighted lottery’ procedures. Unweighted lottery procedures do not ‘compound’ prior structural injustices. However, Schmidt et al do gesture towards a real problem with unweighted lotteries that previous advocates of lottery-based allocation procedures, myself included, have previously overlooked. On the basis that there are independent reasons to prefer lottery-based allocation of scarce lifesaving healthcare resources, I (...)
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  81.  2
    Ethics Briefing – December 2021.Dominic Norcliffe-Brown, Sophie Brannan, Martin Davies, Veronica English, Caroline Ann Harrison & Julian C. Sheather - 2022 - Journal of Medical Ethics 48 (2):150-152.
    In a recent judgment1 the Court of Protection was highly critical of health professionals for continuing to provide clinically-assisted nutrition and hydration in the face of disagreement about the patient’s best interests, without seeking to resolve the issue. This hearing had been set up specifically to consider whether GU’s dignity had been properly protected, and if not why not, given concerns raised by the Official Solicitor about what she considered to be “a complete abrogation of responsibility to consider properly or (...)
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  82.  15
    Case for Persuasion in Parental Informed Consent to Promote Rational Vaccine Choices.Jennifer O'Neill - 2022 - Journal of Medical Ethics 48 (2):106-111.
    There have been calls for mandatory vaccination legislation to be introduced into the UK in order to tackle the national and international rise of vaccine-preventable disease. While some countries have had some success associated with mandatory vaccination programmes, the Royal College of Paediatrics and Child Health insist this is not a suitable option for the UK, a country which has seen historical opposition to vaccine mandates. There is a lack of comprehensive data to demonstrate a direct link between mandatory vaccination (...)
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  83. Ethics of Fetal Reduction: A Reply to My Critics.Joona Räsänen - 2022 - Journal of Medical Ethics 48 (2):142-143.
    In the article, Twin pregnancy, fetal reduction and the ‘all or nothing problem’, I argued that there is a moral problem in multifetal pregnancy reduction from a twin to a singleton pregnancy. Drawing on Horton’s original version of the ‘all or nothing problem’, I argued that there are two intuitively plausible claims in 2-to-1 MFPR: aborting both fetuses is morally permissible, aborting only one of the twin fetuses is morally wrong. Yet, with the assumption that one should select permissible choice (...)
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  84. Twin Pregnancy, Fetal Reduction and the 'All or Nothing Problem’.Joona Räsänen - 2022 - Journal of Medical Ethics 48 (2):101-105.
    Fetal reduction is the practice of reducing the number of fetuses in a multiple pregnancy, such as quadruplets, to a twin or singleton pregnancy. Use of assisted reproductive technologies increases the likelihood of multiple pregnancies, and many fetal reductions are done after in vitro fertilisation and embryo transfer, either because of social or health-related reasons. In this paper, I apply Joe Horton’s all or nothing problem to the ethics of fetal reduction in the case of a twin pregnancy. I argue (...)
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  85.  5
    Prioritisation for Therapies Based on a Disorder’s Severity: Ethics and Practicality.Nigel S. B. Rawson & John Adams - 2022 - Journal of Medical Ethics 48 (2):95-96.
    As the 20th century began, few effective therapies existed. This soon changed with major therapeutic discoveries turning the century into what has been called the golden age of therapeutics.1 The emphasis of most of these developments was on medicines for common disorders as they presented the greatest need. However, it also allowed pharmaceutical manufacturers to produce blockbuster drugs that provided a large return on investment. Rare disorders were overlooked because most are genetic in origin and scientific knowledge was lacking, making (...)
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  86.  4
    Rare and Common Diseases Should Be Treated Equally and Why the Article by de Magalhaes Somewhat Misses its’ Mark.Lars Sandman - 2022 - Journal of Medical Ethics 48 (2):97-98.
    In the article Should rare diseases get special treatment? by Monica Q F de Magalhaes,1 it is argued that rarity is not a morally relevant feature to consider in prioritising treatment in healthcare, but severity is. A central conclusion in the article is that severity rather than prevalence should guide different cost-effectiveness thresholds. Hence, I take it, she answers no to the question in her own heading. I agree with all of this—and with most of her other arguments and conclusions (...)
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  87.  3
    Sequential Organ Failure Assessment, Ventilator Rationing and Evolving Triage Guidance: New Evidence Underlines the Need to Recognise and Revise, Unjust Allocation Frameworks.Harald Schmidt, Dorothy E. Roberts & Nwamaka D. Eneanya - 2022 - Journal of Medical Ethics 48 (2):136-138.
    We respond to recent comments on our proposal to improve justice in ventilator triage, in which we used as an example New Jersey’s publicly available and legally binding Directive Number 2020-03. We agree with Bernard Lo and Doug White that equity implications of triage frameworks should be continually reassessed, which is why we offered six concrete options for improvement, and called for monitoring the consequences of adopted triage models. We disagree with their assessment that we mis-characterised their Model Guidance, as (...)
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  88.  18
    Rationing, Racism and Justice: Advancing the Debate Around ‘Colourblind’ COVID-19 Ventilator Allocation.Harald Schmidt, Dorothy E. Roberts & Nwamaka D. Eneanya - 2022 - Journal of Medical Ethics 48 (2):126-130.
    Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. In the USA, such rationing has unique social justice dimensions. Structural elements of dominant allocation frameworks simultaneously advantage white communities, and disadvantage Black communities—who already experience a disproportionate burden of COVID-19-related job losses, hospitalisations and mortality. Using the example of New Jersey’s Crisis Standard of Care policy, we describe how dominant rationing guidance compounds for many Black patients prior unfair structural disadvantage, chiefly due to the way creatinine and (...)
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  89.  2
    Centring Race, Deprivation, and Disease Severity in Healthcare Priority Setting.Arianne Shahvisi - 2022 - Journal of Medical Ethics 48 (2):77-78.
    The fair distribution of health resources is critical to health justice. But distributing healthcare equitably requires careful attention to the existing distribution of other resources, and the economic system which produces these inequalities. Health is strongly determined by socioeconomic factors, such as the effects of racism on the health of communities of colour, as well as the broader market-oriented healthcare and pharmaceutical systems that put the pursuit of profit above the alleviation of suffering. Two papers in this issue confront health (...)
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  90.  6
    Transitions in Decision-Making Authority at the End of Life: A Problem of Law, Ethics and Practice in Deceased Donation.Shih-Ning Then & Dominique E. Martin - 2022 - Journal of Medical Ethics 48 (2):112-117.
    Where a person is unable to make medical decisions for themselves, law and practice allows others to make decisions on their behalf. This is common at the end of a person’s life where decision-making capacity is often lost. A further, and separate, decision that is often considered at the time of death is whether the person wanted to act as an organ or tissue donor. However, in some jurisdictions, the lawful decision-maker for the donation decision is different from the person (...)
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  91.  8
    Practising What We Preach: Clinical Ethicists’ Professional Perspectives and Personal Use of Advance Directives.Jason Adam Wasserman, Mark Christopher Navin, Victoria Drzyzga & Tyler S. Gibb - 2022 - Journal of Medical Ethics 48 (2):144-149.
    The field of clinical bioethics strongly advocates for the use of advance directives to promote patient autonomy, particularly at the end of life. This paper reports a study of clinical bioethicists’ perceptions of the professional consensus about advance directives, as well as their personal advance care planning practices. We find that clinical bioethicists are often sceptical about the value of advance directives, and their personal choices about advance directives often deviate from what clinical ethicists acknowledge to be their profession’s recommendations. (...)
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  92.  3
    Promoting Equity with a Multi-Principle Framework to Allocate Scarce ICU Resources.Douglas White & Bernard Lo - 2022 - Journal of Medical Ethics 48 (2):133-135.
    We wholeheartedly agree with Schmidt and colleagues’ efforts to promote equity in intensive care unit triage. We also take issue with their characterisation of the New Jersey allocation framework for ICU beds and ventilators, which is modelled after the multi-principle allocation framework we developed early in the pandemic. They characterise it as a two-criterion allocation framework and claim—without evidence—that it will ‘compound disadvantage for black patients’. However, the NJ triage framework—like the model allocation policy we developed—actually contains four allocation criteria: (...)
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  93.  10
    High Court Should Not Restrict Access to Puberty Blockers for Minors.Cameron Beattie - 2022 - Journal of Medical Ethics 48 (1):71-76.
    Gender dysphoria is a clinically significant incongruence between expressed gender and assigned gender, with rapidly growing prevalence among children. The UK High Court recently conducted a judicial review regarding the service provision at a youth-focussed gender identity clinic in Tavistock. The high court adjudged it ‘highly unlikely’ that under-13s, and ‘doubtful’ that 14–15 years old, can be competent to consent to puberty blocker therapy for GD. They based their reasoning on the limited evidence regarding efficacy, the likelihood of progressing to (...)
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  94.  9
    Voluntary Sterilisation of Young Childless Women: Not so Fast.Zeljka Buturovic - 2022 - Journal of Medical Ethics 48 (1):46-49.
    An increasing number of bioethicists are raising concerns that young childless women requesting sterilisation as means of birth control are facing unfair obstacles. It is argued that these obstacles are inconsistent, paternalistic, that they reflect pronatalist bias and that men seem to face fewer obstacles. It is commonly recommended that physicians should change their approach to this type of patient. In contrast, I argue that physicians’ reluctance to eagerly follow an unusual request is understandable and that whatever obstacles result from (...)
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  95.  3
    In the Room When It Happens.Paul Chin & Guillermo A. Palchik - 2022 - Journal of Medical Ethics 48 (1):31-31.
    Medicine has historically been slow to adopt new technologies. Although telepsychiatry was already to some degree in use before the COVID-19 pandemic, the imposed limitations on person-to-person contacts accelerated its growth exponentially. Outcome studies have generally supported telepsychiatry’s use,1 but the breathtaking rapid shift from in-person to video visits across psychiatry has occurred prior to more in-depth examinations on the fundamental changes to the nature of the patient–physician interface. In their paper: “Can you hear me?”: communication, relationship and ethics in (...)
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  96.  1
    Avoiding Hypersensitive Reluctance to Address Parental Responsibility in Childhood Obesity.Eli Feiring, Gloria Traina, Joar Røkke Fystro & Bjorn Hofmann - 2022 - Journal of Medical Ethics 48 (1):65-69.
    Childhood obesity is an increasing health problem. Prior empirical research suggests that, although discussing lifestyle behaviours with parents could help prevent childhood obesity and its health-related consequences, physicians are reluctant to address parental responsibility in the clinical setting. Therefore, this paper questions whether parents might be responsible for their children’s obesity, and if so, whether parental responsibility ought to be addressed in the physician–patient/parent encounter. We illustrate how different ideal-typical models of the physician–patient/parent interaction emphasise different understandings of patient autonomy (...)
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  97.  1
    The Concise Argument – Choice, Choices and the Choice Agenda.Lucy Frith - 2022 - Journal of Medical Ethics 48 (1):1-2.
    Choice is probably one of the most often discussed areas in bioethics, alongside the related concepts of informed consent and autonomy. It is generally, prima facie, portrayed as a good thing. In healthcare, the 2000s saw the UK Prime Minister Tony Blair pursue the ‘Choice Agenda’ where, ‘As capacity expands, so choice will grow. Choice will fundamentally change the balance of power in the NHS.’1 In a consumerist society giving consumers more choice is seen as desirable. However, choice is not (...)
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  98.  3
    ‘Can You Hear Me?’: Communication, Relationship and Ethics in Video-Based Telepsychiatric Consultations.Eva-Maria Frittgen & Joschka Haltaufderheide - 2022 - Journal of Medical Ethics 48 (1):22-30.
    Telepsychiatry has long been discussed as a supplement to or substitute for face-to-face therapeutic consultations. The current pandemic crisis has fueled the development in an unprecedented way. More and more psychiatric consultations are now carried out online as video-based consultations. Treatment results appear to be comparable with those of face-to-face care in terms of clinical outcome, acceptance, adherence and patient satisfaction. However, evidence on videoconferencing in a variety of different fields indicates that there are extensive changes in the communication behaviour (...)
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  99.  9
    Patients’ and Public Views and Attitudes Towards the Sharing of Health Data for Research: A Narrative Review of the Empirical Evidence.Shona Kalkman, Johannes van Delden, Amitava Banerjee, Benoît Tyl, Menno Mostert & Ghislaine van Thiel - 2022 - Journal of Medical Ethics 48 (1):3-13.
    Introduction International sharing of health data opens the door to the study of the so-called ‘Big Data’, which holds great promise for improving patient-centred care. Failure of recent data sharing initiatives indicates an urgent need to invest in societal trust in researchers and institutions. Key to an informed understanding of such a ‘social license’ is identifying the views patients and the public may hold with regard to data sharing for health research. Methods We performed a narrative review of the empirical (...)
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  100.  4
    Operating Room Time as a Limited Resource: Ethical Considerations for Allocation.Patrick David Kelly, Joseph B. Fanning & Brian Drolet - 2022 - Journal of Medical Ethics 48 (1):14-18.
    Scheduling surgical procedures among operating rooms is mistakenly regarded as merely a tedious administrative task. However, the growing demand for surgical care and finite hours in a day qualify OR time as a limited resource. Accordingly, the objective of this manuscript is to reframe the process of OR scheduling as an ethical dilemma of allocating scarce medical resources. Recommendations for ethical allocation of OR time—based on both familiar and novel ethical values—are provided for healthcare institutions and individual surgeons. All data (...)
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  101.  4
    Mind the Gap Please: Ethical Considerations in the Transition of Virtual Consultations From Crisis to Usual Care.Tania Moerenhout - 2022 - Journal of Medical Ethics 48 (1):36-37.
    Although telepsychiatry consultations have been tried and tested for several years, at least in relatively limited numbers and settings, the current COVID-19 pandemic has caused an exponential increase in their application. Even as lockdown restrictions were lifted and a return to face-to-face consultations was possible, many practitioners and patients decided to uphold teleconsultations for some or a large part of their interactions. This was mostly driven by the exceptional circumstances of the pandemic, as ongoing safety concerns, the need for PPE (...)
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  102.  7
    Sustainable Healthcare Resource Allocation, Grounding Theories and Operational Principles: Response to Our Commentators.Christian Munthe, Davide Fumagalli & Erik Malmqvist - 2022 - Journal of Medical Ethics 48 (1):38-38.
    We proposed adding a sustainability principle to the operational ethical principles guiding public healthcare resources allocation decisions. All our commentators acknowledge our core message: healthcare needs to pay attention to the future. They also strengthen our proposal by offering support by luck egalitarian and Rawlsian arguments, and helpfully point out ambiguities and gaps requiring attention in the further development of the proposal, and its practical implementation.
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  103.  7
    Deidentification of Facial Photographs: A Survey of Editorial Policies and Practices.Marija Roguljić, Ivan Buljan, Nika Veček, Ružica Dragun, Matko Marušić, Elizabeth Wager & Ana Marušić - 2022 - Journal of Medical Ethics 48 (1):56-60.
    We analysed all journals from two Journal Citation Reports categories: ‘Dentistry, Oral Surgery and Medicine’ and ‘Otorhinolaryngology’ published in 2018 for their policies on publishing facial photographs and actual practices of publishing these photographs in articles. We extracted the following data for each journal: JCR category, impact factor, volume, issue, instructions for authors regarding ethical issues, instructions for photograph deidentification, journals’ references to standard research and publishing policies, presence and type of published clinical images, separate informed consent for the publication (...)
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  104.  4
    Withholding Conflicts of Interest: The Many Flaws of the New ICMJE Disclosure Form.David Shaw - 2022 - Journal of Medical Ethics 48 (1):19-21.
    In this article, I describe and analyse the proposed new International Committee of Medical Journal Editors form for disclosing conflicts of interest and conclude that it has many flaws. The form does not mention ‘conflicts of interest’ even once in either its body or its title, it introduces a conceptually confused categorisation of different potential conflicts and it ignores future conflicts and intellectual biases. Finally, many of the authors of the new form have themselves failed to declare relevant potential conflicts (...)
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  105.  1
    Withholding or Withdrawing Life Support in Long-Term Neurointensive Care Patients: A Single-Centre, Prospective, Observational Pilot Study.Maria-Ioanna Stefanou, Mihaly Sulyok, Martin Koehnlein, Franziska Scheibe, Robert Fleischmann, Sarah Hoffmann, Benjamin Hotter, Ulf Ziemann, Andreas Meisel & Annerose Maria Mengel - 2022 - Journal of Medical Ethics 48 (1):50-55.
    Purpose Scarce evidence exists regarding end-of-life decision in neurocritically ill patients. We investigated the factors associated with EOLD making, including the group and individual characteristics of involved healthcare professionals, in a multiprofessional neurointensive care unit setting. Materials and methods A prospective, observational pilot study was conducted between 2013 and 2014 in a 10-bed NICU. Factors associated with EOLD in long-term neurocritically ill patients were evaluated using an anonymised survey based on a standardised questionnaire. Results 8 physicians and 24 nurses participated (...)
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  106.  2
    Ethics of Telepsychiatry Versus Face-to-Face Treatment: Let the Patients Make Their Autonomous Choice.Manuel Trachsel & Jana Sedlakova - 2022 - Journal of Medical Ethics 48 (1):32-33.
    There is robust scientific evidence from meta-analyses in psychotherapy research that common factors such as the alliance between patients and therapists, empathy, goal consensus/collaboration, positive regard/affirmation and genuineness have a much greater effect on the overall psychotherapy outcome than the so-called specific factors like particular treatment methods or ingredients of therapy.1 The current evidence base also suggests that the effects of telepsychiatric treatment are comparable with those of face-to-face treatment, not only regarding clinical outcome parameters but also with respect to (...)
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  107.  4
    Priority Setting and Personal Health Responsibility: An Analysis of Norwegian Key Policy Documents.Gloria Traina & Eli Feiring - 2022 - Journal of Medical Ethics 48 (1):39-45.
    Background The idea that individuals are responsible for their health has been the focus of debate in the theoretical literature and in its concrete application to healthcare policy in many countries. Controversies persist regarding the form, substance and fairness of allocating health responsibility to the individual, particularly in universal, need-based healthcare systems. Objective To examine how personal health responsibility has been framed and rationalised in Norwegian key policy documents on priority setting. Methods Documents issued or published by the Ministry of (...)
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  108.  2
    ‘Yes We Hear You. Do You Hear Us?’. A Sociopolitical Approach to Video-Based Telepsychiatric Consultations.Tijs Vandemeulebroucke, Alice Cavolo & Chris Gastmans - 2022 - Journal of Medical Ethics 48 (1):34-35.
    The COVID-19 pandemic has had, and still has, the risk to have an enormous impact on how people socially interact with each other due to possible lockdowns, quarantine and isolation measures to reduce infection rates. Consequently, these measures hold great implications for those medical disciplines that inherently rely on social interaction, such as psychiatry. In their article, ‘Can you hear me?’— Communication, Relationship and Ethics in Video-based Telepsychiatric Consultations’, Frittgen and Haltaufderheide1 show that videoconferencing holds potential to ensure that this (...)
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  109.  11
    Value of Choice.Tom Walker - 2022 - Journal of Medical Ethics 48 (1):61-64.
    Accounts of the value of patient choice in contemporary medical ethics typically focus on the act of choosing. Being the one to choose, it is argued, can be valuable either because it enables one to bring about desired outcomes, or because it is a way of enacting one’s autonomy. This paper argues that all such accounts miss something important. In some circumstances, it is having the opportunity to choose, not the act of choosing, that is valuable. That is because in (...)
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  110. Ethics of Vaccine Refusal.Michael Kowalik - 2022 - Journal of Medical Ethics (48):240-243.
    Proponents of vaccine mandates typically claim that everyone who can be vaccinated has a moral or ethical obligation to do so for the sake of those who cannot be vaccinated, or in the interest of public health. I evaluate several previously undertheorised premises implicit to the ‘obligation to vaccinate’ type of arguments and show that the general conclusion is false: there is neither a moral obligation to vaccinate nor a sound ethical basis to mandate vaccination under any circumstances, even for (...)
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  111.  33
    Equipoise, Standard of Care, and Consent: Responding to the Authorisation of New COVID-19 Treatments in Randomised Controlled Trials.Soren Holm, Jonathan Lewis & Rafael Dal-Ré - 2022 - Journal of Medical Ethics:1-6.
    In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of Molnupiravir, a novel antiviral medicine aimed (...)
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  112.  8
    COVID-19 Vaccination Status Should Not Be Used in Triage Tie-Breaking.Olivia Schuman, Joelle Robertson-Preidler & Trevor M. Bibler - 2022 - Journal of Medical Ethics:1-3.
    This article discusses the triage response to the COVID-19 delta variant surge of 2021. One issue that distinguishes the delta wave from earlier surges is that by the time it became the predominant strain in the USA in July 2021, safe and effective vaccines against COVID-19 had been available for all US adults for several months. We consider whether healthcare professionals and triage committees would have been justified in prioritising patients with COVID-19 who are vaccinated above those who are unvaccinated (...)
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