Year:

  1.  2
    Triage, Consent and Trusting Black Boxes.Kenneth Boyd - 2021 - Journal of Medical Ethics 47 (5):289-290.
    The coronavirus pandemic has brought to public attention a variety of questions long debated in medical ethics, but now given both added urgency and wider publicity. Among these is triage, with its origins in deciding which individual lives are to be saved on a battlefield, but now also concerned with the allocation of scarce resources more generally. On the historical battlefield, decisions about whom to treat first – neither those who would survive without treatment, nor those who would not survive (...)
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  2.  1
    Imperfect by Design: The Problematic Ethics of Surgical Training.Connor Brenna & Sunit Das - 2021 - Journal of Medical Ethics 47 (5):350-353.
    There exists in academic medicine a core ethical issue that is seldom pursued: trainees are frequently not the best person in the operating room at a given intervention being performed, and yet as a profession we understand a fundamental need to afford them opportunities to perform. Academic centres are traditionally associated with a higher quality of care than non-academic centres, suggesting that practical measures exist within teaching hospitals that effectively mask the clinical discrepancies between trainees and their preceptors. Nonetheless, we (...)
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  3. Ethical Considerations for Protecting the Options of Subjects in Primary Epidemic Vaccine Trials.Arthur L. Caplan & Jerrold L. Abraham - 2021 - Journal of Medical Ethics 47 (5):360-360.
    The recent review by Monrad1 presents several issues about secondary vaccine trials. It lays out the case in which a vaccine has been tested through phases I–III and is being deployed. Subsequently, consideration is being given to conducting ‘trials for another vaccine for the pathogen’. Monrad states: ‘In summary, we may say that researchers have strong prima facie reasons not to conduct a secondary vaccine trial.’ Monrad discusses several factors meriting careful consideration about the need for developing and testing more (...)
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  4.  3
    Public Health Decisions in the COVID-19 Pandemic Require More Than ‘Follow the Science’.Thana Cristina de Campos-Rudinsky & Eduardo Undurraga - 2021 - Journal of Medical Ethics 47 (5):296-299.
    Although empirical evidence may provide a much desired sense of certainty amidst a pandemic characterised by uncertainty, the vast gamut of available COVID-19 data, including misinformation, has instead increased confusion and distrust in authorities’ decisions. One key lesson we have been gradually learning from the COVID-19 pandemic is that the availability of empirical data and scientific evidence alone do not automatically lead to good decisions. Good decision-making in public health policy, this paper argues, does depend on the availability of reliable (...)
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  5.  9
    Who is Afraid of Black Box Algorithms? On the Epistemological and Ethical Basis of Trust in Medical AI.Juan Manuel Durán & Karin Rolanda Jongsma - 2021 - Journal of Medical Ethics 47 (5):medethics-2020-106820.
    The use of black box algorithms in medicine has raised scholarly concerns due to their opaqueness and lack of trustworthiness. Concerns about potential bias, accountability and responsibility, patient autonomy and compromised trust transpire with black box algorithms. These worries connect epistemic concerns with normative issues. In this paper, we outline that black box algorithms are less problematic for epistemic reasons than many scholars seem to believe. By outlining that more transparency in algorithms is not always necessary, and by explaining that (...)
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  6.  2
    National Health System Cuts and Triage Decisions During the COVID-19 Pandemic in Italy and Spain: Ethical Implications.Maurizio P. Faggioni, Fermín Jesús González-Melado & Maria Luisa Di Pietro - 2021 - Journal of Medical Ethics 47 (5):300-307.
    In this paper, we analyse the most important documents establishing the criteria for the treatment and exclusion of COVID-19 patients, especially in regard to the giving of respiratory support, in Italy and Spain. These documents reflect a tension that stems from limited healthcare resources which are insufficient to save lives that, under normal conditions, could have been saved, or at least could have received the best possible treatment. First, we analyse the healthcare systems of these two countries before the spread (...)
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  7.  3
    Gender Dysphoria in Adolescents: Can Adolescents or Parents Give Valid Consent to Puberty Blockers?Simona Giordano, Fae Garland & Soren Holm - 2021 - Journal of Medical Ethics 47 (5):324-328.
    This article considers the claim that gender diverse minors and their families should not be able to consent to hormonal treatment for gender dysphoria. The claim refers particularly to hormonal treatment with so-called ‘blockers’, analogues that suspend temporarily pubertal development. We discuss particularly four reasons why consent may be deemed invalid in these cases: the decision is too complex; the decision-makers are too emotionally involved; the decision-makers are on a ‘conveyor belt’; the possibility of detransitioning. We examine each of these (...)
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  8.  5
    Trustworthy Medical AI Systems Need to Know When They Don’T Know.Thomas Grote - 2021 - Journal of Medical Ethics 47 (5):337-338.
    There is much to learn from Durán and Jongsma’s paper.1 One particularly important insight concerns the relationship between epistemology and ethics in medical artificial intelligence. In clinical environments, the task of AI systems is to provide risk estimates or diagnostic decisions, which then need to be weighed by physicians. Hence, while the implementation of AI systems might give rise to ethical issues—for example, overtreatment, defensive medicine or paternalism2—the issue that lies at the heart is an epistemic problem: how can physicians (...)
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  9.  1
    Is One Narrative Enough? Analytical Tools Should Match the Problems They Address.Nathan Hodson & Susan Bewley - 2021 - Journal of Medical Ethics 47 (5):357-359.
    Jeff Nisker describes his personal experience of a diagnosis of advanced prostate cancer and the kindnesses he received from friendly doctors. He claims that this narrative account supports the promotion of Prostate Specific Antigen screening for asymptomatic men and impugns statisticians, mistakenly thinking that their opposition to PSA screening derives from concerns about financial cost. The account inadvertently demonstrates the danger of over-reliance on a single ethical tool for critical analysis. In the first part of this response, we describe the (...)
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  10.  18
    Vaccine Ethics: An Ethical Framework for Global Distribution of COVID-19 Vaccines.Nancy S. Jecker, Aaron G. Wightman & Douglas S. Diekema - 2021 - Journal of Medical Ethics 47 (5):308-317.
    This paper addresses the just distribution of vaccines against the SARS-CoV-2 virus and sets forth an ethical framework that prioritises frontline and essential workers, people at high risk of severe disease or death, and people at high risk of infection. Section I makes the case that vaccine distribution should occur at a global level in order to accelerate development and fair, efficient vaccine allocation. Section II puts forth ethical values to guide vaccine distribution including helping people with the greatest need, (...)
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  11.  13
    In Defence of Gestatelings: Response to Colgrove.Elselijn Kingma - 2021 - Journal of Medical Ethics 47 (5):355-356.
    Ectogestation—that is, ‘artificial’ or extramammalian pregnancy—may soon be within technological reach. This confronts us with questions about the correct moral and legal attitude towards the subjects of this technology, which are called ‘gestatelings’. Colgrove argues that gestatelings are a kind of newborn, and consequently should have the same moral and legal protections as newborns. This paper responds that both claims are unsupported by his arguments, which equivocate on two understandings of the term ‘newborn’. Questions about the appropriate moral and legal (...)
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  12.  4
    Should Age Matter in COVID-19 Triage? A Deliberative Study.Margot N. I. Kuylen, Scott Y. Kim, Alexander Ruck Keene & Gareth S. Owen - 2021 - Journal of Medical Ethics 47 (5):291-295.
    The COVID-19 pandemic put a large burden on many healthcare systems, causing fears about resource scarcity and triage. Several COVID-19 guidelines included age as an explicit factor and practices of both triage and ‘anticipatory triage’ likely limited access to hospital care for elderly patients, especially those in care homes. To ensure the legitimacy of triage guidelines, which affect the public, it is important to engage the public’s moral intuitions. Our study aimed to explore general public views in the UK on (...)
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  13.  5
    Concerning a Seemingly Intractable Feature of the Accountability Gap.Benjamin Lang - 2021 - Journal of Medical Ethics 47 (5):336-336.
    The authors put forward an interesting response to detractors of black box algorithms. According to the authors, what is of ethical relevance for medical artificial intelligence is not so much their transparency, but rather their reliability as a process capable of producing accurate and trustworthy results. The implications of this view are twofold. First, it is permissible to implement a black box algorithm in clinical settings, provided the algorithm’s epistemic authority is tempered by physician expertise and consideration of patient autonomy. (...)
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  14.  5
    Balancing Health Worker Well-Being and Duty to Care: An Ethical Approach to Staff Safety in COVID-19 and Beyond.Rosalind J. McDougall, Lynn Gillam, Danielle Ko, Isabella Holmes & Clare Delany - 2021 - Journal of Medical Ethics 47 (5):318-323.
    The COVID-19 pandemic has highlighted the risks that can be involved in healthcare work. In this paper, we explore the issue of staff safety in clinical work using the example of personal protective equipment in the COVID-19 crisis. We articulate some of the specific ethical challenges around PPE currently being faced by front-line clinicians, and develop an approach to staff safety that involves balancing duty to care and personal well-being. We describe each of these values, and present a decision-making framework (...)
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  15.  2
    Transparent AI: Reliabilist and Proud.Abhishek Mishra - 2021 - Journal of Medical Ethics 47 (5):341-342.
    Durán et al argue in ‘Who is afraid of black box algorithms? On the epistemological and ethical basis of trust in medical AI’1 that traditionally proposed solutions to make black box machine learning models in medicine less opaque and more transparent are, though necessary, ultimately not sufficient to establish their overall trustworthiness. This is because transparency procedures currently employed, such as the use of an interpretable predictor,2 cannot fully overcome the opacity of such models. Computational reliabilism, an alternate approach to (...)
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  16.  8
    Process of Risk Assessment by Research Ethics Committees: Foundations, Shortcomings and Open Questions.Pranab Rudra & Christian Lenk - 2021 - Journal of Medical Ethics 47 (5):343-349.
    Risks and burdens in the study participation, as well as an adequate risk-benefit balance, are key concepts for the evaluation of clinical studies by research ethics committees. An adequate assessment and continuous monitoring to ensure compliance of risks and burdens in clinical trials have long been described as a central task in research ethics. However, there is currently no uniform and solid theoretical approach to risk assessment by RECs. Regulatory standards of research ethics such as the Declaration of Helsinki provide (...)
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  17.  81
    We Might Be Afraid of Black-Box Algorithms.Carissa Veliz, Milo Phillips-Brown, Carina Prunkl & Ted Lechterman - 2021 - Journal of Medical Ethics 47 (5):339-40.
    Fears of black-box algorithms are multiplying. They are said to prevent accountability,1 to make it harder to detect bias2 and so on. Some fears concern the epistemology of black-box algorithms in medicine and the ethical implications of that epistemology. In ‘Who is afraid of black box algorithms? On the epistemological and ethical basis of trust in medical AI,’3 Juan Durán and Jongsma seek to allay such fears. While we find some of their arguments compelling, we still see reasons for fear. (...)
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  18.  3
    Impact of Ectogenesis on the Medicalisation of Pregnancy and Childbirth.Victoria Adkins - 2021 - Journal of Medical Ethics 47 (4):239-243.
    The medicalisation of pregnancy and childbirth has been encouraged by the continuing growth of technology that can be applied to the reproductive journey. Technology now has the potential to fully separate reproduction from the human body with the prospect of ectogenesis—the gestation of a fetus outside of the human body. This paper considers the issues that have been caused by the general medicalisation of pregnancy and childbirth and the impact that ectogenesis may have on these existing issues. The medicalisation of (...)
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  19.  7
    Promoting Racial Equity in COVID-19 Resource Allocation.Lori Bruce & Ruth Tallman - 2021 - Journal of Medical Ethics 47 (4):208-212.
    Due to COVID-19’s strain on health systems across the globe, triage protocols determine how to allocate scarce medical resources with the worthy goal of maximising the number of lives saved. However, due to racial biases and long-standing health inequities, the common method of ranking patients based on impersonal numeric representations of their morbidity is associated with disproportionately pronounced racial disparities. In response, policymakers have issued statements of solidarity. However, translating support into responsive COVID-19 policy is rife with complexity. Triage does (...)
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  20.  8
    Embracing Slippery Slope on Physician-Assisted Suicide and Euthanasia Could Have Significant Unintended Consequences.Zeljka Buturovic - 2021 - Journal of Medical Ethics 47 (4):257-258.
    In a recent article Joshua James Hatherley argues that, if physician-assisted suicide is morally permissible for patients suffering from somatic illnesses, it should be permissible for psychiatric patients as well. He argues that psychiatric disorders do not necessarily impair decision-making ability, that they are not necessarily treatable and that legalising PAS for psychiatric patients would not diminish research and therapeutic interest in psychiatric treatments or impair their recovery through loss of hope. However, by erasing distinction between somatic and psychiatric disorders (...)
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  21.  3
    Ethics of Research at the Intersection of COVID-19 and Black Lives Matter: A Call to Action.Natasha Crooks, Geri Donenberg & Alicia Matthews - 2021 - Journal of Medical Ethics 47 (4):205-207.
    This paper describes how to ethically conduct research with Black populations at the intersection of COVID-19 and the Black Lives Matter movement. We highlight the issues of historical mistrust in the USA and how this may impact Black populations’ participation in COVID-19 vaccination trials. We provide recommendations for researchers to ethically engage Black populations in research considering the current context. Our recommendations include understanding the impact of ongoing trauma, acknowledging historical context, ensuring diverse research teams and engaging in open and (...)
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  22.  7
    Medical Assistance in Dying for the Psychiatrically Ill Reply to Buturovic.Joshua James Hatherley - 2021 - Journal of Medical Ethics 47 (4):259-260.
    In a recent Response published in the Journal of Medical Ethics,1 Buturovic provides two criticisms of my argument in ‘Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory?’2 First, Buturovic argues that my argument effectively ‘erases the distinction between healthy adults and patients essentially implying that PAS [physician-assisted suicide] should be available to all, for all reasons or, ultimately no reason’. Second, Buturovic argues that opening the doors to medical assistance in dying for psychiatric patients could have (...)
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  23.  3
    A Surrogate’s Secrets Are(N’T) Safe with Me: Patient Confidentiality in the Care of a Gestational Surrogate.Claire Horner & Paul Burcher - 2021 - Journal of Medical Ethics 47 (4):213-217.
    Gestational surrogacy relies on a legal agreement between the surrogate and the intended parents to define the roles and responsibilities of the parties, including explicit consent by the surrogate to allow the physician to release all pregnancy-related medical information to the intended parents. In the event of surrogate misconduct, however, physicians may feel conflicted if the surrogate asks the physician to withhold information about potentially dangerous behaviour in pregnancy from the intended parents. While the American Society for Reproductive Medicine guidelines (...)
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  24.  11
    Advance Euthanasia Directives and the Dutch Prosecution.Jonathan A. Hughes - 2021 - Journal of Medical Ethics 47 (4):253-256.
    In a recent Dutch euthanasia case, a woman underwent euthanasia on the basis of an advance directive, having first been sedated without her knowledge and then restrained by members of her family while the euthanasia was administered. This article considers some implications of the criminal court’s acquittal of the doctor who performed the euthanasia. Supporters of advance euthanasia directives have welcomed the judgement as providing a clarification of the law, especially with regard to the admissibility of contextual evidence in interpreting (...)
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  25.  10
    Parental Obligation and Compelled Caesarean Section: Careful Analogies and Reliable Reasoning About Individual Cases.Elselijn Kingma & Lindsey Porter - 2021 - Journal of Medical Ethics 47 (4):280-286.
    Whether it is morally permissible to compel women to undergo a caesarean section is a topic of longstanding debate. Despite plenty of arguments against the moral permissibility of a forced caesarean section, the question keeps cropping up. This paper seeks to scrutinise a particular moral argument in favour of compulsion: the appeal to parental obligation. We present what we take to be a distillation of the basic form of this argument. We then argue that, in the absence of an exhaustive (...)
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  26.  7
    Non-Directed Postmortem Sperm Donation: Some Questions.Frederick Kroon & Ben Kroon - 2021 - Journal of Medical Ethics 47 (4):261-262.
    In their recent ‘The ethical case for non-directed postmortem sperm donation’, Hodson and Parker outline and defend the concept of voluntary non-directed postmortem sperm donation, the idea that men should be able to register their desire to donate their sperm after death for use by strangers since this would offer a potential means of increasing the quantity and heterogeneity of donor sperm. In this response, we raise some concerns about their proposal, focusing in particular on the fact that current methodologies (...)
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  27.  5
    Time and Meaning in the Void Between Hope and Despair.Dan Mahoney - 2021 - Journal of Medical Ethics 47 (4):229-230.
    It is with gratitude to Professor Wilkinson that I assemble these thoughts to the beautiful and haunting melodies of Schubert’s String Quartet No. 14. In the practice of paediatric palliative care, the wavering tension between the Maiden’s Cry and Death’s Response, that dance between hope and despair, unfolds daily in similarly beautiful and haunting ways. Schubert’s interpretation of the dialogue offers welcome connection across time and space. In that context, Wilkinson takes on the challenging question of what it means for (...)
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  28.  6
    Less Nonsense Upon Stilts: The Analysis of Rights in Medical Ethics.John McMillan - 2021 - Journal of Medical Ethics 47 (4):203-204.
    Bentham’s famous remark was a response to the assertation of natural rights that did not depend on law or some other foundation for their normative force.1 Whatever we make of that claim, it flags a problem for making and evaluating rights-based arguments in medical ethics. He wasn’t trying to say that rights are all meaningless, nor that we can readily do without them. Rather, it’s an objection to a particular way of asserting rights where they are taken to express free (...)
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  29.  2
    Death and the Neonate.Bryanna Moore & John D. Lantos - 2021 - Journal of Medical Ethics 47 (4):227-228.
    Dominic Wilkinson suggests that one of Schubert’s songs has relevance for neonatologists today. In the song, Schubert suggests that death sometimes comes as a friend. Wilkinson ponders whether the song has a message for doctors and parents, who sometimes struggle to figure out whether death is an enemy or a friend to a dying baby. Wilkinson reflects on the case of baby ‘Hal’, who was born with serious cardiomyopathy. Hal’s parents and doctors disagree about whether to withdraw life-support. Through his (...)
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  30.  3
    Forced Caesareans: Applying Ordinary Standards to an Extraordinary Case.Hafez Ismaili M’Hamdi & Inez de Beaufort - 2021 - Journal of Medical Ethics 47 (4):233-238.
    Is it morally justifiable to force non-consenting pregnant women to submit to caesarean surgery to save their fetus in distress? Even though proponents and opponents largely agree on the interests at stake, such as the health and life of the fetus and the respect for bodily integrity and autonomy of pregnant women, they disagree on which moral weight to attach to these interests. This is why disagreements about the justifiability of forced caesareans tend to be pervasive and intractable. To sidestep (...)
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  31.  2
    Ethics Briefing – February 2021.Dominic Norcliffe-Brown, Sophie Brannan, Martin Davies, Veronica English, Rebecca Mussell & Julian C. Sheather - 2021 - Journal of Medical Ethics 47 (4):287-288.
    In December, the National Data Guardian 1 for health and care in England, Dame Fiona Caldicott, published the outcomes of a public consultation about the Caldicott Principles and the role of Caldicott Guardians.1 The Caldicott Principles are good practice guidelines which have been used by health and social care organisations in the UK since 1997 to ensure that people’s data are kept safe and used in an ethical way.2 The role of the Caldicott Guardian is well-established in the UK. Caldicott (...)
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  32.  2
    Postmortem Non-Directed Sperm Donation: Quality Matters.Joshua Parker & Nathan Hodson - 2021 - Journal of Medical Ethics 47 (4):263-264.
    In our paper ‘The ethical case for non-directed postmortem sperm donation’ we argued that it would be ethical for men to donate sperm after death for use by strangers. In their thoughtful response Fredrick and Ben Kroon lay out practical concerns regarding our proposal. They raise issues regarding the quality of sperm collected postmortem based on empirical studies. Second, they claim that concerns about quality would make women unlikely to use sperm collected after death. In this response we explore issues (...)
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  33.  3
    Non-Medical Egg Freezing and Individualisation Arguments: Reply to Moen, Segers and Campo-Engelstein.Thomas Søbirk Petersen - 2021 - Journal of Medical Ethics 47 (4):265-266.
    An argument against the use of non-medical egg freezing is that women should not use NMEF as it is an individualistic and morally problematic answer to the social problems that women face, for instance, in the labour market. Instead of allowing or expecting women to deal with these problems individually, we should address them by challenging the patriarchal structure of the labour market—for example, by securing equal pay and affordable childcare. In a recent article in Journal of Medical Ethics, I (...)
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  34.  5
    Ethics of Placebo Use in Clinical Practice: Why We Need to Look Beyond Deontology.Rosanna Plowman & Sally Spurr - 2021 - Journal of Medical Ethics 47 (4):271-273.
    Beneficent clinical usage of placebos has been a problem for the application of Kant’s deontology in medical ethics, which, in its strictest form, rejects deception universally. Some defenders of deontology have countered this by arguing placebos can be used by a physician without necessarily being deceptive. In this paper we argue that such a manipulation of Kant’s absolutism is not credible, and therefore, that we should look beyond deontology in our consideration of placebo usage in clinical practice. We conclude that (...)
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  35.  5
    Blockchain, Consent and Prosent for Medical Research.Sebastian Porsdam Mann, Julian Savulescu, Philippe Ravaud & Mehdi Benchoufi - 2021 - Journal of Medical Ethics 47 (4):244-250.
    Recent advances in medical and information technologies, the availability of new types of medical data, the requirement of increasing numbers of study participants, as well as difficulties in recruitment and retention, all present serious problems for traditional models of specific and informed consent to medical research. However, these advances also enable novel ways to securely share and analyse data. This paper introduces one of these advances—blockchain technologies—and argues that they can be used to share medical data in a secure and (...)
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  36.  5
    Art of Accepting the ‘Least Bad’ Death.Trisha M. Prentice - 2021 - Journal of Medical Ethics 47 (4):225-226.
    That which constitutes a ‘good death’, or dying well, has long been of interest to philosophers and clinicians alike. While difficult to define due to its deeply personal nature and dependency on spiritual and cultural beliefs and past experiences, Wilkinson1 has drawn parallels from art and music to consider key ethical components. Few in clinical practice would dispute that a ‘good death’ is one that does not rob the person of a valuable life, is aligned with the preferences of the (...)
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  37.  3
    Pros and Cons of Prosent as an Alternative to Traditional Consent in Medical Research.Vasiliki Nataly Rahimzadeh - 2021 - Journal of Medical Ethics 47 (4):251-252.
    In their recent article, Porsdam Mann et al propose to share biomedical research data more widely, securely and efficiently using blockchain technologies. 1 They present compelling arguments for how the blockchain presents both a technological innovation, and a deontologically grounded policy innovation to traditional research consent. Their proposal can be read in conversation with a rich body of evidence to suggest current consent processes are problematic on at least one of tripartite bases in biomedical research: that it be fully informed. (...)
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  38.  2
    Old Problems in Need of New (Narrative) Approaches? A Young Physician–Bioethicist’s Search for Ethical Guidance in the Practice of Physician-Assisted Dying in the Netherlands.Bernadette Roest - 2021 - Journal of Medical Ethics 47 (4):274-279.
    The current empirical research and normative arguments on physician-assisted dying in the Netherlands seem insufficient to provide ethical guidance to general practitioners in the practice of PAD, due to a gap between the evidence and arguments on the one hand and the uncertainties and complexities as found in everyday practice on the other. This paper addresses the problems of current ethical arguments and empirical research and how both seem to be profoundly influenced by the Dutch legislative framework on PAD and (...)
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  39.  5
    Dissonance and Consonance About Death.Dominic Wilkinson - 2021 - Journal of Medical Ethics 47 (4):231-232.
    In their three thoughtful commentaries on my essay, Prentice, Mahoney and Moore and Lantos reflect on the challenges that I set out: can we make sense of the notion of a good death, and can we use art and music to provide any insights into it?1–3 I was thinking about these questions again while reading this week of yet another UK legal dispute relating to life-sustaining treatment for a child. In January, the High Court heard the case of Pippa Knight, (...)
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  40.  7
    Sleep Softly: Schubert, Ethics and the Value of Dying Well.Dominic Wilkinson - 2021 - Journal of Medical Ethics 47 (4):218-224.
    Ethical discussions about medical treatment for seriously ill babies or children often focus on the ‘value of life’ or on ‘quality of life’ and what that might mean. In this paper, I look at the other side of the coin—on the value of death, and on the quality of dying. In particular, I examine whether there is such a thing as a good way to die, for an infant or an adult, and what that means for medical care. To do (...)
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  41.  3
    Ethical Issues Raised by Intergenerational Monitoring in Clinical Trials of Germline Gene Modification.Austen Yeager - 2021 - Journal of Medical Ethics 47 (4):267-270.
    As research involving gene editing continues to advance, we are headed in the direction of being able to modify the human germline. Should we reach a point where an argument can be made that the benefits of preventing unborn children and future generations from inheriting genetic conditions that cause tremendous suffering outweigh the risks associated with altering the human germline, the next step will be to design clinical trials using this technology in humans. These clinical trials will likely require careful (...)
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  42. Disentangling the Individualisation Argument Against Non-Medical Egg Freezing From Feminist Critiques.Lisa Campo-Engelstein - 2021 - Journal of Medical Ethics 47 (3):171-172.
    According to Petersen, ‘the individualization argument against NMEF [nonmedical egg freezing]’ states: ‘it is morally wrong to let individuals use technology X [NMEF] – in order to try to handle a problem that is social in nature – if the use of X [NMEF] will somehow work against a social solution to a social problem P [gender inequality in the labor market]’. While there may be individuals making individualisation argument against NMEF, I do not read the scholars he discusses—Karey Harwood,1 (...)
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  43.  5
    Can Bioethics Be an Honest Way of Making a Living? A Reflection on Normativity, Governance and Expertise.Silvia Camporesi & Giulia Cavaliere - 2021 - Journal of Medical Ethics 47 (3):159-163.
    The authority of bioethics as a field of inquiry and of bioethicists as scholars with a distinctive expertise is being questioned on various fronts. Sarah Franklin’s 2019 Nature commentary ‘Ethical research – the long and bumpy road from shirked to shared’ is the latest example. In this paper, we respond to these challenges by focusing on two key issues. First, we discuss the theory and practice of bioethics. We argue that both of these endeavours are fundamental components of this field (...)
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  44.  1
    Insight is a Useful Construct in Clinical Assessments If Used Wisely.Anthony David & Kevin Ariyo - 2021 - Journal of Medical Ethics 47 (3):185-186.
    Medical ethicist, Guidry-Grimes has critically reviewed the concept of insight, voicing concerns that it lacks consensus as to its components and that it undermines patient perspectives. We respond by briefly summarising research over the last 30 years that she overlooks which has helped establish the clinical validity of the construct. This includes the adoption of standardised assessment tools—at least in research—and longitudinal and cross-sectional studies quantifying associations with psychopathological, clinical and cognitive measures. We also make the distinction between the current (...)
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  45.  7
    Pain Versus Suffering: A Distinction Currently Without a Difference.Charlotte Mary Duffee - 2021 - Journal of Medical Ethics 47 (3):175-178.
    My paper challenges an influential distinction between pain and suffering put forward by physician-ethicist, Eric Cassell. I argue that Cassell’s distinction is philosophically untenable because he contrasts suffering with an outdated theory of pain. In particular, Cassell focuses on one type of pain, the interpretation of nociception induced by noxious stimuli such as heat or sharp objects; yet since the late 1970s, pain scientists have rendered both nociception and noxious stimuli unnecessary for pain. I argue that this discrepancy between Cassell’s (...)
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  46.  17
    Ethical Allocation of Future COVID-19 Vaccines.Rohit Gupta & Stephanie R. Morain - 2021 - Journal of Medical Ethics 47 (3):137-141.
    The COVID-19 pandemic will likely recede only through development and distribution of an effective vaccine. Although there are many unknowns surrounding COVID-19 vaccine development, vaccine demand will likely outstrip early supply, making prospective planning for vaccine allocation critical for ensuring the ethical distribution of COVID-19 vaccines. Here, we propose three central goals for COVID-19 vaccination campaigns: to reduce morbidity and mortality, to minimise additional economic and societal burdens related to the pandemic and to narrow unjust health inequalities. We evaluate five (...)
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  47.  3
    COVID-19 Ventilator Rationing Protocols: Why We Need to Know More About the Views of Those with Most to Lose.Whitney Kerr & Harald Schmidt - 2021 - Journal of Medical Ethics 47 (3):133-136.
    Withholding or withdrawing life-saving ventilators can become necessary when resources are insufficient. With rising cases in many countries, and likely further peaks in the coming colder seasons, ventilator triage guidance remains a central part of the COVID-19 policy response. The dominant model in ventilator triage guidelines prioritises the ethical principles of saving the most lives and saving the most life-years. We sought to ascertain to what extent this focus aligns, or conflicts, with the preferences of disadvantaged minority populations. We conducted (...)
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  48.  1
    Roles of Genetics and Blood Type in Clinical Responses to COVID-19: Ethical and Policy Concerns.Robert Klitzman - 2021 - Journal of Medical Ethics 47 (3):149-151.
    Recently, several genetic variants have been associated with increased or decreased risks of becoming infected and/or seriously ill with COVID-19—not only offering important potential medical benefits but also posing critical ethical questions. These genetic factors, some of which are associated with blood type, may account for variations in observed responses to COVID-19. Hence, assessments of these genetic differences and blood type could provide possible benefits in gauging patients’ risks of disease acquisition and prioritising allocation of interventions or vaccines, if supplies (...)
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  49.  7
    Global Equitable Access to Vaccines, Medicines and Diagnostics for COVID-19: The Role of Patents as Private Governance.Aisling McMahon - 2021 - Journal of Medical Ethics 47 (3):142-148.
    In June 2020, Gilead agreed to provide the USA with 500 000 doses of remdesivir—an antiviral drug which at that time was percieved to show promise in reducing the recovery time for patients with COVID-19. This quantity represented Gilead’s then full production capacity for July and 90% of its capacity for August and September. Similar deals are evident around access to proposed vaccines for COVID-19, and such deals are only likely to increase. These attempts to secure preferential access to medicines (...)
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  50.  4
    A Discussion on Controversies and Ethical Dilemmas in Prostate Cancer Screening.Satish Chandra Mishra - 2021 - Journal of Medical Ethics 47 (3):152-158.
    Prostate cancer is one of the the most common cancers in men. A blood test called prostate-specific antigen has a potential to pick up this cancer very early and is used for screening of this disease. However, screening for prostate cancer is a matter of debate. Level 1 evidence from randomised controlled trials suggests a reduction in cancer-specific mortality from PCa screening. However, there could be an associated impact on quality of life due to a high proportion of overdiagnosis and (...)
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  51.  4
    Individual Solutions to Social Problems.Ole Martin Moen - 2021 - Journal of Medical Ethics 47 (3):173-174.
    Non-medical egg freezing is egg freezing for the sake of delaying parenthood. The label ‘non-medical’ can be confusing, since the extraction and freezing of eggs is undeniably a medical procedure. The point is that whereas ‘medical egg freezing’ is done in order to retain capacity to procreate despite a potentially threatening medical condition, ‘non-medical egg freezing’ is done for the sake of getting more time to find a suitable partner and/or to establish a career before embarking on parenthood. One type (...)
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  52.  1
    A Matter of Time: Grappling with Everyday Ethical Tensions at the Confluence Between Policy and Practice in a Psychiatric Unit.Rossio Motta-Ochoa, Raphael Lencucha, Jiameng Xu & Melissa Park - 2021 - Journal of Medical Ethics 47 (3):179-184.
    ObjectiveTo provide insights on emergent ethical tensions experienced by mental health practitioners during system re-organisation, which is sufficiently grounded in empirical data at the local level to inform policy on recovery at institutional and provincial levels.MethodEthnographic methods using narrative and critical phenomenological resources over 24 months.FindingsEveryday ethical tensions emerged at the confluence of different experiences of time, for example, how a context of increasing pressure to decrease patients’ length of stay at the hospital challenged efforts to listen to and advocate (...)
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  53.  5
    Arguments on Thin Ice: On Non-Medical Egg Freezing and Individualisation Arguments.Thomas Søbirk Petersen - 2021 - Journal of Medical Ethics 47 (3):164-168.
    The aim of this article is to provide a systematic reconstruction and critique of what is taken to be a central ethical concern against the use of non-medical egg freezing. The concern can be captured in what we can call the individualisation argument. The argument states, very roughly, that women should not use NMEF as it is an individualistic and morally problematic solution to the social problems that women face, for instance, in the labour market. Instead of allowing or expecting (...)
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  54.  9
    Delineating the Role of Penile Transplantation When Traditional Male Circumcisions Go Wrong in South Africa.Stuart Rennie & Keymanthri Moodley - 2021 - Journal of Medical Ethics 47 (3):192-193.
    Back in 2017, Moodley and Rennie published a paper in the Journal of Medical Ethics entitled ‘Penile transplantation as an appropriate response to botched traditional circumcisions in South Africa: an argument against.’1 As the title suggests, we took a critical view towards penile transplantation as a way of responding to the problem of young men in South Africa experiencing genital mutilation and amputation as a result of traditional circumcision practices. Our main conclusion was that prevention is key: social, cultural and (...)
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  55.  2
    Should Mitochondrial Replacement Therapy Be Funded by the National Health Service?Sophie Rhys-Evans - 2021 - Journal of Medical Ethics 47 (3):194-198.
    A clinical trial on mitochondrial replacement therapy is currently being conducted and if this technique proves effective, National Health Service England will fund MRT through the highly specialised services funding stream. This paper considers whether MRT should be publicly funded by the NHS. Given the current financial pressure the NHS is experiencing, a comprehensive discussion is essential. There is yet to be a thorough discussion on MRT funding, perhaps because this is a small-scale issue and presumed to be covered by (...)
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  56.  5
    Discussing Social Hierarchies and the Importance of Genetic Ties: A Commentary on Petersen.Seppe Segers - 2021 - Journal of Medical Ethics 47 (3):169-170.
    I am happy to comment on T S Petersen’s1 examination of the ‘individualization argument against non-medical egg freezing ’. Petersen intervenes in the ethical discussion on egg freezing by critically reconsidering a specific type of argument against oocyte cryopreservation for reasons that are not directly related with medical issues. Petersen dissects the claim that such non-medical usage is ‘an individualistic and morally problematic solution to the social problems that women face, for instance, in the labour market’.1 Proponents of this argument (...)
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  57. Defending the Distinction Between Pregnancy and Parenthood.Prabhpal Singh - 2021 - Journal of Medical Ethics 47 (3):189-191.
    In this paper, I respond to criticisms toward my account of the difference in moral status between fetuses and newborns. I show my critics have not adequately argued for their view that pregnant women participate in a parent-child relationship. While an important counterexample is raised against my account, this counterexample had already been dealt with in my original paper. Because the criticisms against my account lack argumentative support, they do not pose a problem for my account. I conclude the raised (...)
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  58.  19
    Triage and Justice in an Unjust Pandemic: Ethical Allocation of Scarce Medical Resources in the Setting of Racial and Socioeconomic Disparities.Benjamin Tolchin, Sarah C. Hull & Katherine Kraschel - 2021 - Journal of Medical Ethics 47 (3):200-202.
    Shortages of life-saving medical resources caused by COVID-19 have prompted hospitals, healthcare systems, and governmentsto develop crisis standards of care, including 'triage protocols' to potentially ration medical supplies during the public health emergency. At the same time, the pandemic has highlighted and exacerbated racial, ethnic, and socioeconomic health disparities that together constitute a form of structural racism. These disparities pose a critical ethical challenge in developing fair triage systems that will maximize lives saved without perpetuating systemic inequities. Here we review (...)
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  59. Advancing Technologies as Both Our Saviour and Our Doom.Jesse Wall - 2021 - Journal of Medical Ethics 47 (3):131-132.
    Olaf has a theory about advancing technologies being both our saviour and our doom. While we ought to avoid over-analysing claims of fictitious snowmen, we can pause to consider whether it is possible for an advancing technology to be both our saviour and our doom. I will maintain that it is. But for now, note how it is tempting to resolve the overlap by thinking about advancing technologies and individuals. In a possible reformulation of Olaf’s claim, advancing technology can be (...)
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  60.  5
    How the Past Matters for the Future: A Luck Egalitarian Sustainability Principle for Healthcare Resource Allocation.Andreas Albertsen - 2021 - Journal of Medical Ethics 47 (2):102-103.
    Christian Munthe, David Fumagalli and Erik Malmqvist argue that well-known healthcare resource allocation principles, such as need, prognosis, equal treatment and cost-effectiveness, should be supplemented with a principle of sustainability.1 Employing such a principle would entail that the allocation of healthcare resources should take into account whether a specific allocation causes negative dynamics, which would limit the amount of resources available in the future. As examples of allocation decisions, which may have such negative dynamics, they mention those who cause a (...)
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  61.  8
    Ethical Challenges for Women’s Healthcare Highlighted by the COVID-19 Pandemic.Bethany Bruno, David I. Shalowitz & Kavita Shah Arora - 2021 - Journal of Medical Ethics 47 (2):69-72.
    Healthcare policies developed during the COVID-19 pandemic to safeguard community health have the potential to disadvantage women in three areas. First, protocols for deferral of elective surgery may assign a lower priority to important reproductive outcomes. Second, policies regarding the prevention and treatment of COVID-19 may not capture the complexity of the considerations related to pregnancy. Third, policies formulated to reduce infectious exposure inadvertently may increase disparities in maternal health outcomes and rates of violence towards women. In this commentary, we (...)
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  62.  11
    Mistrust and Inconsistency During COVID-19: Considerations for Resource Allocation Guidelines That Prioritise Healthcare Workers.Alexander T. M. Cheung & Brendan Parent - 2021 - Journal of Medical Ethics 47 (2):73-77.
    As the USA contends with another surge in COVID-19 cases, hospitals may soon need to answer the unresolved question of who lives and dies when ventilator demand exceeds supply. Although most triage policies in the USA have seemingly converged on the use of clinical need and benefit as primary criteria for prioritisation, significant differences exist between institutions in how to assign priority to patients with identical medical prognoses: the so-called ‘tie-breaker’ situations. In particular, one’s status as a frontline healthcare worker (...)
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  63.  4
    Grow the Pie, or the Resource Shuffle? Commentary on Munthe, Fumagalli and Malmqvist.Ben Davies - 2021 - Journal of Medical Ethics 47 (2):98-99.
    John Rawls’s ‘just savings’ principle is among the better-known attempts to outline how we should balance the claims of the present with the claims of the future generations on resources. A central element of Rawls’s approach involves endorsing a sufficientarian approach, where our central obligation is to ensure ‘the conditions needed to establish and to preserve a just basic structure’.1 This engaging paper by Christian Munthe, Davide Fumagalli and Erik Malmqvist does not explicitly mention Rawls’s work on this issue.2 Still, (...)
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  64.  8
    Withdrawing Treatment From Patients with Prolonged Disorders of Consciousness: The Presumption in Favour of the Maintenance of Life is Legally Robust.Charles Foster - 2021 - Journal of Medical Ethics 47 (2):119-120.
    The question a judge has to ask in deciding whether or not life-sustaining treatment should be withdrawn is whether the continued treatment is lawful. It will be lawful if it is in the patient’s best interests. Identifying this question gives no guidance about how to approach the assessment of best interests. It merely identifies the judge’s job. The presumption in favour of the maintenance of life is part of the job that follows the identification of the question.The presumption is best (...)
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  65.  6
    Solidarity, Sustainability and Medical Ethics.Zoë Fritz - 2021 - Journal of Medical Ethics 47 (2):63-64.
    In this issue of the Journal of Medical Ethics arguments are cogently made that sustainability and solidarity should be considered as core medical ethical principles, and that more explicit attention should be given to the complex context in which a decision is made. Munthe et al propose that sustainability should become an established principle for justifying healthcare resource allocation, and should be an explicit factor in procuring drugs and other resources.1 They argue that the current operational norms which guide decision (...)
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  66.  10
    Don’T Stop Thinking About Tomorrow.Alexander Guerrero - 2021 - Journal of Medical Ethics 47 (2):100-101.
    Maybe you only have 1000 units of some resource, but 10,000 people need the resource or would benefit from it. One question: why do you control the resource? Leave that aside for now. A second question: how should you allocate the resource? If you are a decision-maker in a health system, and if the resource has to do with medicine or public health, we are in the world of the ethics of scarce resource allocation decisions in healthcare. Munthe et al (...)
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  67.  6
    Sex Robots for Older Adults with Disabilities: Reply to Critics.Nancy S. Jecker - 2021 - Journal of Medical Ethics 47 (2):113-113.
    In ‘Nothing to Be Ashamed of: Sex Robots for Older Adults with Disabilities,’1 I make the case that the unwanted absence of sex from a person’s life represents not just a loss of physical pleasure, but a loss of dignity. Since people aged 65 and over suffer disproportionately from disabilities that impair sexual functioning, I focus on this population. Drawing on an analysis of dignity developed at greater length elsewhere,2 I argue that sex robots can help older adults with disabilities (...)
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  68.  12
    What Does Solidarity Do for Bioethics?Avery Kolers - 2021 - Journal of Medical Ethics 47 (2):122-128.
    Bioethical work on solidarity has yielded an array of divergent conceptions. But what do these accounts add to normative bioethics? What is solidarity’s distinctive social normative role? Prainsack and Buyx suggest that solidarity be understood as the ‘putty’ of justice. I argue here that the putty metaphor is deeply insightful and—when spelled out in detail—successfully explicates solidarity’s social normative function. Unfortunately, Prainsack and Buyx’s own account cannot play this role. I propose instead that the putty metaphor supports a conception of (...)
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  69.  2
    Using a Biomarker Acutely to Identify Babies at Risk of Serious Adverse Effects From Antibiotics: Where is the ‘Terrible Moral and Medical Dilemma’?Anneke M. Lucassen, John Henry McDermott & William Newman - 2021 - Journal of Medical Ethics 47 (2):117-118.
    We thank Parker and Wright for engaging in this roundtable debate in such a spirited way. The ‘Pharmacogenetic [test] to Avoid Loss of Hearing’ Trial is the first time a genetic point of care test has been applied in the acute neonatal setting; therefore, it is not surprising that questions have been raised which require debate, discussion and clarification. Parker and Wright misattribute several assumptions to the roundtable authors, which we would like to clarify here. Since they raise wider questions (...)
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  70.  9
    Sustainability Principle for the Ethics of Healthcare Resource Allocation.Christian Munthe, Davide Fumagalli & Erik Malmqvist - 2021 - Journal of Medical Ethics 47 (2):90-97.
    We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness gives rise to what we call negative dynamics: a gradual depletion of the value possible to generate through healthcare. These principles should therefore be complemented by a sustainability principle, making the prospect of negative dynamics a further factor to consider, and possibly outweigh considerations highlighted by the other principles. We (...)
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  71.  2
    Ethics Briefing.Dominic Norcliffe-Brown, Sophie Brannan, Martin Davies, Veronica English, Rebecca Mussell & Julian C. Sheather - 2021 - Journal of Medical Ethics 47 (2):129-130.
    On 8 October 2020, the British Medical Association published the results of its survey of BMA members on physician-assisted dying. With 28 986 respondents, this was one of the largest surveys of medical opinion on this topic ever carried out. This represents 19.35% of those who received an invitation to participate and the respondents were broadly representative of the BMA’s overall membership. The BMA was clear throughout this process that the results of the survey would not determine its policy. Its (...)
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  72.  5
    Terrible Choices in the Septic Child: A Response to the PALOH Trial Round Table Authors.Joshua Parker & David Wright - 2021 - Journal of Medical Ethics 47 (2):114-116.
    In this response article, we challenge a core assumption that lies at the centre of a round table discussion regarding the Pharmacogenetics to Avoid Loss of Hearing trial. The round table regards a genetic test for a variant that increases the risk of deafness if a carrier is given the antibiotic gentamicin. The idea is that rapid testing can identify neonates at risk, providing an opportunity to prevent giving an antibiotic that might cause deafness. We challenge the assumption that a (...)
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  73.  5
    Sustainability, Equal Treatment, and Temporal Neutrality.Govind Persad - 2021 - Journal of Medical Ethics 47 (2):106-107.
    Addressing distributive justice issues in health policy—ranging from the allocation of health system funding to the allocation of scarce COVID-19 interventions like intensive care unit beds and vaccines—involves the application of ethical principles. Should a principle of sustainability be among them? I suggest that while the value of temporal neutrality underlying such a principle is compelling, it is already implicit in the more basic principle of equal treatment. Munthe et al 1 imagine sustainability accompanying four other principles: need, prognosis, equal (...)
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  74.  30
    Good Reasons to Vaccinate: Mandatory or Payment for Risk?Julian Savulescu - 2021 - Journal of Medical Ethics 47 (2):78-85.
    Mandatory vaccination, including for COVID-19, can be ethically justified if the threat to public health is grave, the confidence in safety and effectiveness is high, the expected utility of mandatory vaccination is greater than the alternatives, and the penalties or costs for non-compliance are proportionate. I describe an algorithm for justified mandatory vaccination. Penalties or costs could include withholding of benefits, imposition of fines, provision of community service or loss of freedoms. I argue that under conditions of risk or perceived (...)
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  75.  1
    Moral Flux in Primary Care : The Effect of Complexity.John Spicer, Sanjiv Ahluwalia & Rupal Shah - 2021 - Journal of Medical Ethics 47 (2):86-89.
    In this article, we examine the inter-relationship between moral theory and the unpredictable and complex world of primary health care, where the values of patient and doctor, or groups of patients and doctors, may often clash. We introduce complexity science and its relevance to primary care; going on to explore how it can assist in understanding ethical decision making, as well as considering implications for clinical practice. Throughout the article, we showcase aspects and key concepts using examples and a case (...)
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  76.  1
    Reflective Disequilibrium: A Critical Evaluation of the Complete Lives Framework for Healthcare Rationing.Xavier Symons - 2021 - Journal of Medical Ethics 47 (2):108-112.
    One prominent view in recent literature on resource allocation is Persad, Emanuel and Wertheimer’s complete lives framework for the rationing of lifesaving healthcare interventions. CLF states that we should prioritise the needs of individuals who have had less opportunity to experience the events that characterise a complete life. Persad et al argue that their system is the product of a successful process of reflective equilibrium—a philosophical methodology whereby theories, principles and considered judgements are balanced with each other and revised until (...)
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  77.  3
    Promoting the Sustainability of Healthcare Resources with Existing Ethical Principles: Scarce COVID-19 Medications, Vaccines and Principled Parsimony.Gerard Vong - 2021 - Journal of Medical Ethics 47 (2):104-105.
    Munthe et al 1 argue for an asymmetry between positive and negative dynamics that justifies a new sustainability principle among the operational principles for ethical healthcare resource allocation. The purported asymmetry is that while positive dynamics are ‘taken into account in present applications of the operational principles…, negative dynamics are not’.1 Positive dynamics occur when allocations in the present lead to there being more healthcare resources per health need in the future, whereas negative dynamics occur when present allocations lead to (...)
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  78.  9
    Solidarity is for Other People: Identifying Derelictions of Solidarity in Responses to COVID-19.Peter West-Oram - 2021 - Journal of Medical Ethics 47 (2):65-68.
    The role and importance of solidarity for effective health provision is the subject of lengthy and heated debate which has been thrown into even sharper relief by the COVID-19 pandemic. In various ways, and by various authorities we have all been asked, even instructed, to engage in solidarity with one another in order to collectively respond to the current crisis. Under normal circumstances, individuals can engage in solidarity with their compatriots in the context of public health provision in a number (...)
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  79.  10
    Considering Sex Robots for Older Adults with Cognitive Impairments.Andria Bianchi - 2021 - Journal of Medical Ethics 47 (1):37-38.
    Determining whether and/or how to enable older persons with disabilities to engage in sex raises several ethical considerations. With the goal of enabling the sexual functioning of older adults with disabilities, Jecker argues that sex robots could be used as a helpful tool. In her article, ‘Nothing to be Ashamed of: Sex Robots for Older Adults with Disabilities’, Jecker acknowledges the importance of sexual functioning and the fact that ageist assumptions incorrectly classify older persons as asexual. Additionally, older adults may (...)
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  80.  9
    Are Sex Robots Enough?Alexander A. Boni-Saenz - 2021 - Journal of Medical Ethics 47 (1):35-35.
    Nancy Jecker’s essay Nothing to be Ashamed of: Sex Robots for Older Adults with Disabilities 1 presents a provocative application of the capabilities approach. Her ethical argument for providing access to sex robots for older adults with disabilities proceeds in five parts: 1. Older adults frequently suffer disabilities that impair sexual functioning. 2. The ability to function sexually is linked to central human capabilities, including: the ability to generate a personally meaningful life narrative; be physically, mentally and emotionally healthy; experience (...)
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  81.  3
    Paramedic Delivery of Bad News: A Novel Dilemma During the COVID-19 Crisis.Iain Campbell - 2021 - Journal of Medical Ethics 47 (1):16-19.
    As a result of the COVID-19 global pandemic, paramedics in the UK face unprecedented challenges in the care of acutely unwell patients and their family members. This article will describe and discuss a new ethical dilemma faced by clinicians in the out-of-hospital environment during this time, namely the delivery of bad news to family members who are required to remain at home and self-isolate while the critically unwell patient is transported to hospital. I will discuss some failings of current practice (...)
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  82.  10
    Robots and Sexual Ethics.Brian D. Earp & Katarzyna Grunt-Mejer - 2021 - Journal of Medical Ethics 47 (1):1-2.
    Much of modern ethics is built around the idea that we should respect one another’s autonomy. Here, “we” are typically imagined to be adult human beings of sound mind, where the soundness of our mind is measured against what we take to be the typical mental capacities of a neurodevelopmentally “normal” person—perhaps in their mid-thirties or forties. When deciding about what constitutes ethical sex, for example, our dominant models hold that ethical sex is whatever is consented to, while a lack (...)
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  83.  7
    Fair Allocation of Scarce Medical Resources in the Time of COVID-19: What Do People Think?Francesco Fallucchi, Marco Faravelli & Simone Quercia - 2021 - Journal of Medical Ethics 47 (1):3-6.
    The COVID-19 pandemic has placed an enormous burden on health systems, and guidelines have been developed to help healthcare practitioners when resource shortage imposes the choice on who to treat. However, little is known on the public perception of these guidelines and the underlying moral principles. Here, we assess on a sample of 1033 American citizens’ moral views and agreement with proposed guidelines. We find substantial heterogeneity in citizens’ moral principles, often not in line with the guidelines recommendations. As the (...)
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  84.  4
    Incoming Ethical Issues for Deep Brain Stimulation: When Long-Term Treatment Leads to a ‘New Form of the Disease’.Frederic Gilbert & Mathilde Lancelot - 2021 - Journal of Medical Ethics 47 (1):20-25.
    Deep brain stimulation has been regarded as an efficient and safe treatment for Parkinson’s disease since being approved by the Food and Drug Administration in 1997. It is estimated that more than 150 000 patients have been implanted, with a forecasted rapid increase in uptake with population ageing. Recent longitudinal follow-up studies have reported a significant increase in postoperative survival rates of patients with PD implanted with DBS as compared with those not implanted with DBS. Although DBS tends to increase (...)
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  85.  1
    Experiences with Counselling to People Who Wish to Be Able to Self-Determine the Timing and Manner of One’s Own End of Life: A Qualitative in-Depth Interview Study.Martijn Hagens, Marianne C. Snijdewind, Kirsten Evenblij, Bregje D. Onwuteaka-Philipsen & H. Roeline W. Pasman - 2021 - Journal of Medical Ethics 47 (1):39-46.
    BackgroundIn the Netherlands, Foundation De Einder offers counselling to people who wish to be able to self-determine the timing and manner of their end of life.AimThis study explores the experiences with counselling that counselees receive from counsellors facilitated by Foundation De Einder.MethodsOpen coding and inductive analysis of in-depth interviews with 17 counselees.ResultsCounselling ranged from solely receiving information about lethal medication to combining this with psychological counselling about matters of life and death, and the effects for close ones. Counselees appreciated the (...)
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  86.  3
    Fair and Equitable Subject Selection in Concurrent COVID-19 Clinical Trials.Maud O. Jansen, Peter Angelos, Stephen J. Schrantz, Jessica S. Donington, Maria Lucia L. Madariaga & Tanya L. Zakrison - 2021 - Journal of Medical Ethics 47 (1):7-11.
    Clinical trials emerged in rapid succession as the COVID-19 pandemic created an unprecedented need for life-saving therapies. Fair and equitable subject selection in clinical trials offering investigational therapies ought to be an urgent moral concern. Subject selection determines the distribution of risks and benefits, and impacts the applicability of the study results for the larger population. While Research Ethics Committees monitor fair subject selection within each trial, no standard oversight exists for subject selection across multiple trials for the same disease. (...)
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  87.  12
    Nothing to Be Ashamed Of: Sex Robots for Older Adults with Disabilities.Nancy S. Jecker - 2021 - Journal of Medical Ethics 47 (1):26-32.
    This paper spotlights ways in which sexual capacities relate to central human capabilities, such as the ability to generate a personally meaningful story of one’s life; be physically, mentally and emotionally healthy; experience bodily integrity; affiliate and bond with others; feel and express a range of human emotions; and choose a plan of life. It sets forth a dignity-based argument for affording older people access to sex robots as part of reasonable efforts to support their central human capabilities at a (...)
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  88.  8
    Doctors During the COVID-19 Pandemic: What Are Their Duties and What is Owed to Them?Stephanie B. Johnson & Frances Butcher - 2021 - Journal of Medical Ethics 47 (1):12-15.
    Doctors form an essential part of an effective response to the COVID-19 pandemic. We argue they have a duty to participate in pandemic response due to their special skills, but these skills vary between different doctors, and their duties are constrained by other competing rights. We conclude that while doctors should be encouraged to meet the demand for medical aid in the pandemic, those who make the sacrifices and increased efforts are owed reciprocal obligations in return. When reciprocal obligations are (...)
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  89.  7
    Redefining Liberty: Is Natural Inability a Legitimate Constraint of Liberty?Zahra Ladan - 2021 - Journal of Medical Ethics 47 (1):59-62.
    In P v Cheshire West, Lady Hale stated that an act that would deprive an able-bodied or able-minded person of their liberty would do the same to a mentally or physically disabled person. Throughout the judgement, there is no definition of what liberty is, which makes defining an act that would deprive a person of it difficult. Ideas of liberty are described in terms of political liberty within a society, the state of being free from external influence and individual autonomy. (...)
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  90.  5
    How Should the ‘Privilege’ in Therapeutic Privilege Be Conceived When Considering the Decision-Making Process for Patients with Borderline Capacity?Sumytra Menon, Vikki Entwistle, Alastair Vincent Campbell & Johannes J. M. Van Delden - 2021 - Journal of Medical Ethics 47 (1):47-50.
    Therapeutic privilege is a defence that may be available to doctors who fail to disclose to the patient relevant information when seeking informed consent for treatment if they have a reasonable belief that providing that information would likely cause the patient concerned serious physical or mental harm. In a landmark judgement, the Singapore Court of Appeal introduced a novel interpretation of TP, identifying circumstances in which it might be used with patients who did not strictly lack capacity but might be (...)
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  91.  2
    Becoming a Medical Assistance in Dying (MAiD) Provider: An Exploration of the Conditions That Produce Conscientious Participation.Allyson Oliphant & Andrea Nadine Frolic - 2021 - Journal of Medical Ethics 47 (1):51-58.
    The availability of willing providers of medical assistance in dying in Canada has been an issue since a Canadian Supreme Court decision and the subsequent passing of federal legislation, Bill C14, decriminalised MAiD in 2016. Following this legislation, Hamilton Health Sciences in Ontario, Canada, created a team to support access to MAiD for patients. This research used a qualitative, mixed methods approach to data collection, obtaining the narratives of providers and supporters of MAiD practice at HHS. This study occurred at (...)
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  92.  4
    Commentary on Jecker.Tom Sorell - 2021 - Journal of Medical Ethics 47 (1):36-36.
    Jecker’s paper focuses on the value of sex and sexuality in the lives of older people, and she argues that there is nothing wrong with the use of sex robots to realise that value. She concedes that sex robots marketed today are overwhelmingly designed for heterosexual males, and that their appearance corresponds to certain objectionable stereotypes of sexually attractive women, and of exciting sexual practices. Still, she says, sex robots do not have to be like that, and a less stereotype-ridden (...)
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  93.  25
    Sex Robot Fantasies.Robert Sparrow - 2021 - Journal of Medical Ethics 47 (1):33-34.
    Nancy Jecker is right when she says that older persons ought not to be ashamed if they wish to remain sexually active in advanced old age. She offers a useful account of the role that sexuality plays in supporting key human capabilities. However, Jecker assumes an exaggerated account of what sex robots are likely to be able to offer for the foreseeable future when she suggests that we are obligated to make them available to older persons with disabilities. Moreover, whether (...)
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  94.  8
    Strengthened Impairment Argument Does Not Restate Marquis.Bruce Philip Blackshaw - 2021 - Journal of Medical Ethics 1:medethics-2021-107302.
    With Perry Hendricks, I recently outlined a strengthened version of the impairment argument for the immorality of abortion. Alex Gillham has argued that our use of Don Marquis’ deprivation of a ‘future-like ours’ account entails we were merely restating Marquis’ argument for the immorality of abortion. Here, I explain why SIA is more than just a reframing of Marquis.
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  95.  40
    LGBT Testimony and the Limits of Trust.Maura Priest - 2021 - Journal of Medical Ethics (x):xx.
    Draft of forthcoming article in the Journal of Medical Ethics where I discuss ethical tension between LGBT testimony and testimonial trust of medical professionals.
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