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Buruk B, Ekmekci PE, Arda B. An ethical analysis of a prospective new paradigm of life: Nanotechnology-enabled human beings within the framework of principlism. Dev World Bioeth 2024; 24:107-114. [PMID: 36815734 DOI: 10.1111/dewb.12394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
Nanotechnology (NT)-enabled disease-free life is a form of reconstruction of the human body that promises a paradigm shift toward a new form of human existence in an imaginable life. However, as human reconstruction may be within the limits of the concept of "human enhancement," it is not clear to what extent "enhanced humans" will be ethically acceptable or desired. This study discusses the ethical implications of NT-embedded enhanced humans and this new imaginable life. First, ethical concerns arising from the existence of a grey zone of certain dilemmas regarding benefits and possible/unpredicted risks are addressed in terms of the four main principles of bioethics. Then, we focus on the ethical problems in human nano-enhancement. Finally, we study the methods of analyzing these ethical problems within the framework of principlism to conceive a comprehensive and coherent bioethical understanding.
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2
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Valentine RC. Who has a meaningful life? A care ethics analysis of selective trait abortion. Med Health Care Philos 2024; 27:205-216. [PMID: 38308115 DOI: 10.1007/s11019-023-10192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 02/04/2024]
Abstract
Trait Selective Abortions (TSA) have come under critique as a medical practice that presents potential disabled infants as burdens and lacking the potential for meaningful lives. This paper, using the author's background as a disabled person, contends that the philosophy underpinning TSAs reflects liberal society's lack of a theory of needs. The author argues for a care ethics based approach informed by disability analyses to engage with TSAs.
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3
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Martin S, Ancillotti M, Slokenberga S, Matar A. A comparative ethical analysis of the Egyptian clinical research law. BMC Med Ethics 2024; 25:48. [PMID: 38689214 PMCID: PMC11059645 DOI: 10.1186/s12910-024-01040-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/26/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND In this study, we examined the ethical implications of Egypt's new clinical trial law, employing the ethical framework proposed by Emanuel et al. and comparing it to various national and supranational laws. This analysis is crucial as Egypt, considered a high-growth pharmaceutical market, has become an attractive location for clinical trials, offering insights into the ethical implementation of bioethical regulations in a large population country with a robust healthcare infrastructure and predominantly treatment-naïve patients. METHODS We conducted a comparative analysis of Egyptian law with regulations from Sweden and France, including the EU Clinical Trials Regulation, considering ethical human subject research criteria, and used a directed approach to qualitative content analysis to examine the laws and regulations. This study involved extensive peer scrutiny, frequent debriefing sessions, and collaboration with legal experts with relevant international legal expertise to ensure rigorous analysis and interpretation of the laws. RESULTS On the rating of the seven different principles (social and scientific values, scientific validity, fair selection of participants, risk-benefit ratio, independent review, informed consent and respect for participants) Egypt, France, and EU regulations had comparable scores. Specific principles (Social Value, Scientific Value, and Fair selection of participants) were challenging to directly identify due to certain regulations embodying 'implicit' principles more than explicitly stated ones. CONCLUSION The analysis underscores Egypt's alignment with internationally recognized ethical principles, as outlined by Emanuel et al., through its comparison with French, Swedish, and EU regulations, emphasizing the critical need for Egypt to continuously refine its ethical regulations to safeguard participant protection and research integrity. Key issues identified include the necessity to clarify and standardize the concept of social value in research, alongside concerns regarding the expertise and impartiality of ethical review boards, pointing towards a broader agenda for enhancing research ethics in Egypt and beyond.
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Affiliation(s)
- Sylvia Martin
- Center for Research and Bioethics, Uppsala University, Uppsala, Sweden.
| | - Mirko Ancillotti
- Center for Research and Bioethics, Uppsala University, Uppsala, Sweden
| | | | - Amal Matar
- Center for Research and Bioethics, Uppsala University, Uppsala, Sweden
- Clinical Immunology and Transfusion Medicine Department, Uppsala University Hospital, Uppsala, Sweden
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4
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Lachance AD, Steika R, Lutton J, Chessa F. Total Joint Arthroplasty in Patients Who Are Obese or Morbidly Obese: An Ethical Analysis. J Bone Joint Surg Am 2024; 106:659-664. [PMID: 38377222 DOI: 10.2106/jbjs.23.00617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Andrew D Lachance
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, Pennsylvania
| | - Roman Steika
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, Pennsylvania
| | - Jeffrey Lutton
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, Pennsylvania
| | - Frank Chessa
- Maine Medical Center, Portland, Maine
- Tufts University School of Medicine, Boston, Massachusetts
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5
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Pokharel S, Adhikari B, Johnson T, Cheah PY. Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries. BMJ Glob Health 2024; 9:e012874. [PMID: 38569658 PMCID: PMC11002359 DOI: 10.1136/bmjgh-2023-012874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/14/2024] [Indexed: 04/05/2024] Open
Abstract
Antimicrobial resistance (AMR) is a global health and one health problem. Efforts to mitigate the problem of AMR are challenging to implement due to unresolved ethical tensions. We present an in-depth ethical analysis of tensions that might hinder efforts to address AMR. First, there is a tension between access and excess in the current population: addressing lack of access requires facilitating use of antimicrobials for some populations, while addressing excessive use for other populations. Second, there is a tension between personal interests and a wider, shared interest in curbing AMR. These personal interests can be viewed from the perspective of individuals seeking care and healthcare providers whose livelihoods depend on using or selling antimicrobials and who profit from the sales and use of antimicrobials. Third, there is a tension between the interests of current populations and the interests of future generations. Last, there is a tension between addressing immediate health threats such as pandemics, and AMR as a 'silent', chronic threat. For each of these tensions, we apply 'descriptive ethics' methods that draw from existing evidence and our experiences living and working in low-income and middle-income countries to highlight how these ethical tensions apply in such settings.
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Affiliation(s)
- Sunil Pokharel
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Bipin Adhikari
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University Phayathai Campus, Bangkok, Thailand
| | - Tess Johnson
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University Phayathai Campus, Bangkok, Thailand
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6
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Abstract
This article presents a revised version of negative utilitarianism. Previous versions have relied on a hedonistic theory of value and stated that suffering should be minimized. The traditional rebuttal is that the doctrine in this form morally requires us to end all sentient life. To avoid this, a need-based theory of value is introduced. The frustration of the needs not to suffer and not to have one's autonomy dwarfed should, prima facie, be decreased. When decreasing the need frustration of some would increase the need frustration of others, the case is deferred and a fuller ethical analysis is conducted. The author's perceptions on murder, extinction, the right to die, antinatalism, veganism, and abortion are used to reach a reflective equilibrium. The new theory is then applied to consumerism, material growth, and power relations. The main finding is that the burden of proof should be on those who promote the status quo.
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Affiliation(s)
- Matti Häyry
- Philosophy of Management, Department of Management Studies, School of Business, Aalto University, FIN Aalto, Finland
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7
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Jansen SNG, Kamphorst BA, Mulder BC, van Kamp I, Boekhold S, van den Hazel P, Verweij MF. Ethics of early detection of disease risk factors: A scoping review. BMC Med Ethics 2024; 25:25. [PMID: 38443930 PMCID: PMC10913641 DOI: 10.1186/s12910-024-01012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Scientific and technological advancements in mapping and understanding the interrelated pathways through which biological and environmental exposures affect disease development create new possibilities for detecting disease risk factors. Early detection of such risk factors may help prevent disease onset or moderate the disease course, thereby decreasing associated disease burden, morbidity, and mortality. However, the ethical implications of screening for disease risk factors are unclear and the current literature provides a fragmented and case-by-case picture. METHODS To identify key ethical considerations arising from the early detection of disease risk factors, we performed a systematic scoping review. The Scopus, Embase, and Philosopher's Index databases were searched for peer-reviewed, academic records, which were included if they were written in English or Dutch and concerned the ethics of (1) early detection of (2) disease risk factors for (3) disease caused by environmental factors or gene-environment interactions. All records were reviewed independently by at least two researchers. RESULTS After screening 2034 titles and abstracts, and 112 full papers, 55 articles were included in the thematic synthesis of the results. We identified eight common ethical themes: (1) Reliability and uncertainty in early detection, (2) autonomy, (3) privacy, (4) beneficence and non-maleficence, (5) downstream burdens on others, (6) responsibility, (7) justice, and (8) medicalization and conceptual disruption. We identified several gaps in the literature, including a relative scarcity of research on ethical considerations associated with environmental preventive health interventions, a dearth of practical suggestions on how to address expressed concerns about overestimating health capacities, and a lack of insights into preventing undue attribution of health responsibility to individuals. CONCLUSIONS The ethical concerns arising with the early detection of risk factors are often interrelated and complex. Comprehensive ethical analyses are needed that are better embedded in normative frameworks and also assess and weigh the expected benefits of early risk factor detection. Such research is necessary for developing and implementing responsible and fair preventive health policies.
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Affiliation(s)
- Sammie N G Jansen
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment, RIVM, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands.
- Department of Social Sciences, Wageningen University & Research, Hollandseweg 1, Wageningen, 6706 KN, The Netherlands.
| | - Bart A Kamphorst
- Department of Social Sciences, Wageningen University & Research, Hollandseweg 1, Wageningen, 6706 KN, The Netherlands
| | - Bob C Mulder
- Department of Social Sciences, Wageningen University & Research, Hollandseweg 1, Wageningen, 6706 KN, The Netherlands
| | - Irene van Kamp
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment, RIVM, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Sandra Boekhold
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment, RIVM, P.O. Box 1, Bilthoven, 3720 BA, The Netherlands
| | - Peter van den Hazel
- International Network on Children's Health, Environment & Safety (INCHES), Ellecom, the Netherlands
| | - Marcel F Verweij
- Ethics Institute, Utrecht University, Janskerkhof 13a, Utrecht, 3512 BL, The Netherlands
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8
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Riva L. The Physician-Assisted Suicide Pathway in Italy: Ethical Assessment and Safeguard Approaches. J Bioeth Inq 2024; 21:185-192. [PMID: 37831290 PMCID: PMC11052828 DOI: 10.1007/s11673-023-10302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/02/2023] [Indexed: 10/14/2023]
Abstract
Although in Italy there is currently no effective law on physician-assisted suicide or euthanasia, Decision No. 242 issued by the Italian Constitutional Court on September 25, 2019 established that an individual who, under specific circumstances, has facilitated the implementation of an independent and freely-formed resolve to commit suicide by another individual is exempt from criminal liability. Following this ruling, some citizens have submitted requests for assisted suicide to the public health system, generating a situation of great uncertainty in the application processes. As a matter of fact, shared and defined procedures are lacking as Decision 242/2019 merely added some principles on which the legislature will have to base its future intervention. This paper analyses the advisory role that the Decision attributes to territorial ethics committees with the aim of stimulating discussions on their role in oversight mechanisms. The proposed conclusion is that the envisaged role does not appear consistent with the functions of these bodies and is ultimately substantially undefined and unjustified.
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Affiliation(s)
- Luciana Riva
- Bioethics Unit, Istituto Superiore di Sanità, Via Giano della Bella 34, 00162, Roma, Italia.
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9
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Parsons JA, Johal HK, Parker J, Romanis EC. Translational or translationable? A call for ethno-immersion in (empirical) bioethics research. Bioethics 2024; 38:252-261. [PMID: 37478365 DOI: 10.1111/bioe.13184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 07/23/2023]
Abstract
The shift towards "empirical bioethics" was largely triggered by a recognition that stakeholders' views and experiences are vital in ethical analysis where one hopes to produce practicable recommendations. Such perspectives can provide a rich resource in bioethics scholarship, perhaps challenging the researcher's perspective. However, overreliance on a picture painted by a group of research participants-or on pre-existing literature in that field-can lead to a biased view of a given context, as the subjectivity of data generated in these ways cannot (and should not wholly) be escaped. In response, we propose the implementation of a complementary approach of ethno-immersion in bioethics research. By positioning oneself in the context being researched, the researcher can better understand the realities of that context. The researcher's understanding will, naturally, be subjective too. However, it will act as a better developed and more informed outsider view, when considering the picture painted by participants and previous studies, thus enabling the researcher to introduce more nuance when analysing data. We introduce this approach after examining what we call the context detachment problem, whereby some bioethics scholarship-empirical or otherwise-fails to reflect the reality of the healthcare setting it concerns. Our proposed ethno-immersion (which differs from formal ethnography) is then explored as a response, highlighting its benefits, and answering the question of timing within a research project. Finally, we reflect on the applicability of our proposal to non-empirical bioethics scholarship, concluding that it remains important but may require some adjustments.
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Affiliation(s)
- Jordan A Parsons
- Keele Law School, Keele University, Keele, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Joshua Parker
- Lancaster Medical School, Lancaster University, Lancaster, UK
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10
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Kamat S, Agarwal A, Stoff B, Crotty A. An Ethical Analysis of Treatment of an Active-Duty Service Member With Limited Follow-up. Cutis 2024; 113:E7-E8. [PMID: 38593106 DOI: 10.12788/cutis.0960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Samir Kamat
- Dr. Kamat is from Navy Medicine and Readiness Training Center, San Diego, California. Aneesh Agarwal is from the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York. Dr. Stoff is from the Department of Dermatology, Emory University School of Medicine and the Emory Center for Ethics, Atlanta, Georgia. Dr. Crotty is from US Naval Hospital Okinawa, Ginowan, Japan
| | - Aneesh Agarwal
- Dr. Kamat is from Navy Medicine and Readiness Training Center, San Diego, California. Aneesh Agarwal is from the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York. Dr. Stoff is from the Department of Dermatology, Emory University School of Medicine and the Emory Center for Ethics, Atlanta, Georgia. Dr. Crotty is from US Naval Hospital Okinawa, Ginowan, Japan
| | - Benjamin Stoff
- Dr. Kamat is from Navy Medicine and Readiness Training Center, San Diego, California. Aneesh Agarwal is from the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York. Dr. Stoff is from the Department of Dermatology, Emory University School of Medicine and the Emory Center for Ethics, Atlanta, Georgia. Dr. Crotty is from US Naval Hospital Okinawa, Ginowan, Japan
| | - Angela Crotty
- Dr. Kamat is from Navy Medicine and Readiness Training Center, San Diego, California. Aneesh Agarwal is from the Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York. Dr. Stoff is from the Department of Dermatology, Emory University School of Medicine and the Emory Center for Ethics, Atlanta, Georgia. Dr. Crotty is from US Naval Hospital Okinawa, Ginowan, Japan
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11
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Yoshizawa F. Anti-natalism is incompatible with Theory X. Bioethics 2024; 38:114-120. [PMID: 38050896 DOI: 10.1111/bioe.13248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/23/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023]
Abstract
The anti-natalist philosopher David Benatar defends a position asserting that all life is harmful, and that it is, therefore, wrong to have children. In this paper, I critique Benatar's less-discussed claim that his anti-natalism provides solutions to population ethics problems, such as the Non-Identity Problem, the Repugnant Conclusion, and the Mere Addition Problem, all of which are presented in Derek Parfit's Reasons and Persons. Since the publication of his Better Never to Have Been, Benatar has continued to claim that its provision of such solutions strengthens his defense of anti-natalism. Although Benatar's view has received much criticism, this argument has not been discussed at length. I undertake a thorough examination of the argument and identify reasons to reject it. The central point of my critique is that the implications of Benatar's views in determining ranges of wrong and not-wrong cases of procreation are extensionally inadequate when applied to the problems of population ethics.
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Affiliation(s)
- Fumitake Yoshizawa
- Graduate School of Social Sciences, Hitotsubashi University, Tokyo, Japan
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12
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Abstract
In the paper 'COVID-19 vaccine boosters for young adults: a risk-benefit assessment and ethical analysis of mandate policies at universities,' Bardosh et al argued that college mandates of the COVID-19 booster vaccine are unethical. The authors came to this conclusion by performing three different sets of comparisons of benefits versus risks using referenced data and argued that the harm outweighs the risk in all three cases. In this response article, we argue that the authors frame their arguments by comparing values that are not scientifically or reasonably comparable and that the authors used values that represent grossly different risk profiles and grouped them into a set of figures to create an illusion of fair comparisons. We argue that absent the falsely skewed portrayals of a higher level of risk over benefit in their misrepresented figures, the five ethical arguments they presented completely fall apart.
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Affiliation(s)
- Leo L Lam
- CoMotion, University of Washington, Seattle, Washington, USA
| | - Taylor Nichols
- Medicine, University of California San Francisco, San Francisco, California, USA
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Bardosh K, Krug A, Jamrozik E, Lemmens T, Keshavjee S, Prasad V, Makary MA, Baral S, Høeg TB. COVID-19 vaccine boosters for young adults: a risk benefit assessment and ethical analysis of mandate policies at universities. J Med Ethics 2024; 50:126-138. [PMID: 36600579 PMCID: PMC10850707 DOI: 10.1136/jme-2022-108449] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/23/2022] [Indexed: 06/17/2023]
Abstract
In 2022, students at North American universities with third-dose COVID-19 vaccine mandates risk disenrolment if unvaccinated. To assess the appropriateness of booster mandates in this age group, we combine empirical risk-benefit assessment and ethical analysis. To prevent one COVID-19 hospitalisation over a 6-month period, we estimate that 31 207-42 836 young adults aged 18-29 years must receive a third mRNA vaccine. Booster mandates in young adults are expected to cause a net harm: per COVID-19 hospitalisation prevented, we anticipate at least 18.5 serious adverse events from mRNA vaccines, including 1.5-4.6 booster-associated myopericarditis cases in males (typically requiring hospitalisation). We also anticipate 1430-4626 cases of grade ≥3 reactogenicity interfering with daily activities (although typically not requiring hospitalisation). University booster mandates are unethical because they: (1) are not based on an updated (Omicron era) stratified risk-benefit assessment for this age group; (2) may result in a net harm to healthy young adults; (3) are not proportionate: expected harms are not outweighed by public health benefits given modest and transient effectiveness of vaccines against transmission; (4) violate the reciprocity principle because serious vaccine-related harms are not reliably compensated due to gaps in vaccine injury schemes; and (5) may result in wider social harms. We consider counterarguments including efforts to increase safety on campus but find these are fraught with limitations and little scientific support. Finally, we discuss the policy relevance of our analysis for primary series COVID-19 vaccine mandates.
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Affiliation(s)
- Kevin Bardosh
- School of Public Health, University of Washington, Seattle, Washington, USA
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Allison Krug
- Epidemiology, Artemis Biomedical Communications, Virginia Beach, Virginia, USA
| | - Euzebiusz Jamrozik
- University of Oxford Wellcome Centre for Ethics and Humanities, Oxford, UK
| | - Trudo Lemmens
- Faculty of Law and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Vinay Prasad
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Marty A Makary
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stefan Baral
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Tracy Beth Høeg
- Clinical Research, Acumen, LLC, Burlingame, California, USA
- Sierra Nevada Memorial Hospital, Grass Valley, California, USA
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14
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Fredheim OM, Materstvedt LJ, Skulberg I, Magelssen M. Ought the level of sedation to be reduced during deep palliative sedation? A clinical and ethical analysis. BMJ Support Palliat Care 2024; 13:e984-e989. [PMID: 34686524 PMCID: PMC10850687 DOI: 10.1136/bmjspcare-2021-003081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/28/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Deep palliative sedation (DPS) is applied as a response to refractory suffering at the end of life when symptoms cannot be relieved in an awake state. DPS entails a dilemma of whether to provide uninterrupted sedation-in which case DPS would turn into deep and continuous palliative sedation (DCPS) -to minimise the risk that any further intolerable suffering will occur or whether to pause sedation to avoid unnecessary sedation. DPS is problematic in that it leaves the patient 'socially dead' by eradicating their autonomy and conscious experiences. AIM To perform a normative ethical analysis of whether guidelines should recommend attempting to elevate consciousness during DPS. DESIGN A structured analysis based on the four principles of healthcare ethics and consideration of stakeholders' interests. RESULTS When DPS is initiated it reflects that symptom relief is valued above the patient's ability to exercise autonomy and experience social interaction. However, if a decrease in symptom burden occurs, waking could be performed without patients experiencing suffering. Such pausing of deep sedation would satisfy the principles of autonomy and beneficence. Certain patients require substantial dose increases to maintain sedation. Waking such patients risks causing distressing symptoms. This does not happen if deep sedation is kept uninterrupted. Thus, the principle of non-maleficence points towards not pausing sedation. The authors' clinical ethics analysis demonstrates why other stakeholders' interests do not appear to override arguments in favour of providing uninterrupted sedation. CONCLUSION Stopping or pausing DPS should always be considered, but should not be routinely attempted.
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Affiliation(s)
- Olav Magnus Fredheim
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Palliative Medicine, Akershus University Hospital, Lorenskog, Norway
- National Competence Centre for Complex Symptom Disorders, Department of Pain and Complex Disorders, St. Olavs Hospital, Trondheim, Norway
| | - Lars Johan Materstvedt
- Department of Philosophy and Religious Studies, Faculty of Humanities, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Glasgow End of Life Studies Group, School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, Scotland, UK
| | - Ingeborg Skulberg
- Department of Palliative Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Morten Magelssen
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- MF Norwegian School of Theology, Religion and Society, Oslo, Norway
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15
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Sinha I, Dayama S. Antimicrobial stewardship in low- and middle-income countries: Developing a broader perspective through an ethical analysis. Indian J Med Ethics 2024; IX:35-40. [PMID: 38375646 DOI: 10.20529/ijme.2023.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
The increase in the number of cases of antimicrobial resistance has gained attention worldwide. The main drivers of this situation are the misuse and overuse of antimicrobials for human and animal health. The imbalance between ensuring appropriate use of antimicrobials and providing equal access in the community makes this an ethical issue. The antimicrobial stewardship programme was initiated in response to this global crisis. Its framework includes interventions targeting the optimisation of antimicrobials in hospitals. Various countries have adopted stewardship interventions, and many success stories have been published. However, the steering of this programme faces hurdles due to the complexity that surrounds decision making in antimicrobial prescription, and the challenges of health systems in lower and middle income countries like India. Addressing these issues will extend the reach of these programmes, increase their sustainability and promote health-related justice to the community.
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Affiliation(s)
- Isha Sinha
- State IYCF consultant, State Resource Centre, Nalanda Medical College and Hospital, Agamkuan, Patna 800007, Bihar, INDIA
| | - Sonal Dayama
- Assistant Professor, Department of Community Medicine, ESIC Medical College & Hospital, Hyderabad 500038, Telangana, INDIA
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Abstract
Recent global events demonstrate that analytical frameworks to aid professionals in healthcare ethics must consider the pervasive role of social structures in the emergence of bioethical issues. To address this, the authors propose a new sociologically informed approach to healthcare ethics that they term "social bioethics." Their approach is animated by the interpretive social sciences to highlight how social structures operate vis-à-vis the everyday practices and moral reasoning of individuals, a phenomenon known as social discourse. As an exemplar, the authors use social bioethics to reframe common ethical issues in psychiatric services and discuss potential implications. Lastly, the authors discuss how social bioethics illuminates the ways healthcare ethics consultants in both policy and clinical decision-making participate in and shape broader social, political, and economic systems, which then cyclically informs the design and delivery of healthcare.
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Affiliation(s)
- Ryan J Dougherty
- Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, TX, USA
| | - Joseph J Fins
- Weill Cornell Medicine, Division of Medical Ethics, New York, NY, USA
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17
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Sood A, Sangari A, Stoff BK. Recommending expensive treatments: An ethical analysis. J Am Acad Dermatol 2024; 90:216-217. [PMID: 35872260 DOI: 10.1016/j.jaad.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Aditya Sood
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Ayush Sangari
- Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
| | - Benjamin K Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia; Emory Center for Ethics, Atlanta, Georgia.
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18
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Dalziell J, Rogers W. Scientists' Views on the Ethics, Promises and Practices of Synthetic Biology: A Qualitative Study of Australian Scientific Practice. Sci Eng Ethics 2023; 29:41. [PMID: 38082028 DOI: 10.1007/s11948-023-00461-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/01/2023] [Indexed: 12/18/2023]
Abstract
Synthetic biology is a broad term covering multiple scientific methodologies, technologies, and practices. Pairing biology with engineering, synbio seeks to design and build biological systems, either through improving living cells by adding in new functions, or creating new structures by combining natural and synthetic components. As with all new technologies, synthetic biology raises a number of ethical considerations. In order to understand what these issues might be, and how they relate to those covered in ethics literature on synbio, we conducted an interview study with practicing synthetic biologists affiliated with a synthetic biology centre in Australia. Scientists identified a range of ethical challenges germane to the field, including precarious employment, pressures from industry, gender inequity, and the negative effects of the hyping of synbio. These challenges differed markedly from those identified in the ethics literature, whose treatment of the harms and benefits of synbio remains largely speculative and abstract. In our discussion of the pragmatic, every day ethical issues synthetic biologists face, we illustrate how issues of waste or research integrity play pivotal roles in everything from lived experiences in the laboratory, to long-term research trajectories guiding the field. In a confirmation of the ethical relevance of our participant's views on the field, we argue that the subjects they raise must be included in any ethical analysis of synbio as a field.
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Affiliation(s)
- Jacqueline Dalziell
- Department of Philosophy and the ARC Center of Excellence in Synthetic Biology, Macquarie University, Sydney, NSW, Australia.
| | - Wendy Rogers
- Department of Philosophy, and the School of Medicine, Macquarie University, Sydney, NSW, Australia.
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Mertz M, Prince I, Pietschmann I. Values, decision-making and empirical bioethics: a conceptual model for empirically identifying and analyzing value judgements. Theor Med Bioeth 2023; 44:567-587. [PMID: 37589807 PMCID: PMC10643456 DOI: 10.1007/s11017-023-09640-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 08/18/2023]
Abstract
It can be assumed that value judgements, which are needed to judge what is 'good' or 'better' and what is 'bad' or 'worse', are involved in every decision-making process. The theoretical understanding and analysis of value judgements is, therefore, important in the context of bioethics, for example, to be able to ethically assess real decision-making processes in biomedical practice and make recommendations for improvements. However, real decision-making processes and the value judgements inherent in them must first be investigated empirically ('empirical bioethics'). For this to succeed, what exactly a 'value judgement' is and of what components it might consist must initially be theoretically clarified. A corresponding conceptual model can then support or even enable empirical data collection and analysis and, above all, subsequent ethical analysis and evaluation. This paper, therefore, presents a value judgement model with its theoretical derivation. It also illustrates its application in an interview study of decision-making between animal experimentation and alternative methods in the context of biomedical research. Though the model itself can be theoretically deepened and extended, the application of the model works in general and helps to uncover what value judgements can enter into decision-making. However, the empirical methods, for example, qualitative interviews, can also be better oriented towards eliciting value judgements (as understood according to the model). Further applications of the model to other topics or by means of other empirical methods are conceivable.
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Affiliation(s)
- Marcel Mertz
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Ilvie Prince
- Institute of Philosophy, Leibniz University Hannover, Hannover, Germany
| | - Ines Pietschmann
- Department for Medical Ethics and History of Medicine, Goettingen University Medical Center, Goettingen, Germany
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20
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Nakou P, Bennett R. The risk of normative bias in reporting empirical research: lessons learned from prenatal screening studies about the prominence of acknowledged limitations. Theor Med Bioeth 2023; 44:589-606. [PMID: 37930620 PMCID: PMC10643326 DOI: 10.1007/s11017-023-09639-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 11/07/2023]
Abstract
Empirical data can be an extremely powerful and influential tool in bioethical research. However, when researchers or policy makers look for answers to ethical questions by engaging with empirical research, there can be a tendency (conscious or unconscious) to shape, report, and use empirical research in a way that confirms their own preferred ethical conclusions. This skewing effect - what we call 'normative bias' - is often so subtle it falls short of clear misconduct and thus can be difficult to call out. However, we argue that this subtle influence of bias has the potential to significantly influence debate and policy around highly sensitive ethical issues and must be guarded against. In this paper we share the lessons we have learned through a journey of self-reflection around the effect that normative bias can have when reporting on and referring to empirical data relating to ethical issues. We use a variety of papers from our area of the ethics of routine prenatal screening to illustrate these subtle but often powerfully distorting effects of bias. Our aim in doing so is not to criticise the work of others, as we recognise our own normative bias, but to improve awareness of this issue, remind the need for reflexivity to guard against our own biases, and introduce a new criterion - the idea of a 'limitation prominence assessment' - that can work as a practical way to evaluate the seriousness of the limitations of an empirical study and thus, the risks of the study being misread or misinterpreted through superficial reading.
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Affiliation(s)
- Panagiota Nakou
- Department of Law, Centre for Social Ethics and Policy, The University of Manchester, Manchester, M13 9PL, UK.
| | - Rebecca Bennett
- Department of Law, Centre for Social Ethics and Policy, The University of Manchester, Manchester, M13 9PL, UK
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21
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Adams J. Defending explicability as a principle for the ethics of artificial intelligence in medicine. Med Health Care Philos 2023; 26:615-623. [PMID: 37642834 PMCID: PMC10725847 DOI: 10.1007/s11019-023-10175-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
The difficulty of explaining the outputs of artificial intelligence (AI) models and what has led to them is a notorious ethical problem wherever these technologies are applied, including in the medical domain, and one that has no obvious solution. This paper examines the proposal, made by Luciano Floridi and colleagues, to include a new 'principle of explicability' alongside the traditional four principles of bioethics that make up the theory of 'principlism'. It specifically responds to a recent set of criticisms that challenge the supposed need for such a principle to perform an enabling role in relation to the traditional four principles and therefore suggest that these four are sufficient without the addition of explicability. The paper challenges the critics' premise that explicability cannot be an ethical principle like the classic four because it is explicitly subordinate to them. It argues instead that principlism in its original formulation locates the justification for ethical principles in a midlevel position such that they mediate between the most general moral norms and the contextual requirements of medicine. This conception of an ethical principle then provides a mold for an approach to explicability on which it functions as an enabling principle that unifies technical/epistemic demands on AI and the requirements of high-level ethical theories. The paper finishes by anticipating an objection that decision-making by clinicians and AI fall equally, but implausibly, under the principle of explicability's scope, which it rejects on the grounds that human decisions, unlike AI's, can be explained by their social environments.
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Affiliation(s)
- Jonathan Adams
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Kirkeveien 166, Fredrik Holsts hus, Oslo, 0450, Norway.
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22
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Rigby B, Symons X. Abortion, euthanasia, and the limits of principlism. Med Health Care Philos 2023; 26:549-556. [PMID: 37470922 DOI: 10.1007/s11019-023-10162-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/21/2023]
Abstract
Principlism is an ethical framework that has dominated bioethical discourse for the past 50 years. There are differing perspectives on its proper scope and limits. In this article, we consider to what extent principlism provides guidance for the abortion and euthanasia debates. We argue that whilst principlism may be considered a useful framework for structuring bioethical discourse, it does not in itself allow for the resolution of these neuralgic policy discussions. Scholars have attempted to use principlism to analyse the ethics and legality of abortion and euthanasia; but such efforts are methodologically problematic. We close with a consideration of the proper scope of principlism in bioethics-a vision that is more modest than the manner in which principlism is often deployed in contemporary academic bioethics and medical education.
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Affiliation(s)
- Brieann Rigby
- University of Technology Sydney Law School, Level 14 UTS Central (Building 2) 61, Broadway, Ultimo, NSW, 2007, Australia
| | - Xavier Symons
- Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, 12 Arrow Street, Cambridge, MA, 02138, USA.
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23
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de Asúa DR, Olaciregui Dague K, Arriaga A, Herreros B. Animating Clinical Ethics: A Structured Method to Teach Ethical Analysis Through Movies. HEC Forum 2023; 35:325-335. [PMID: 35092518 DOI: 10.1007/s10730-022-09470-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 12/28/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
Abstract
Movies can serve valuable didactic purposes teaching clinical ethics to medical students. However, using film sequences as means to develop critical thinking is not a straightforward task. There is a significant gap in the literature regarding how to analyse the ethical content embedded in these clips systematically, in a way that facilitates the students' transition from anecdotal reflections to abstract thinking. This article offers a pedagogical proposal to approach the ethical analysis of film sequences in a systematic fashion. This structured stepwise method encourages students to identify the main ethical problem of a selected scene and to reflect on the theoretical principles involved, emphasizing the application of these norms and values in a contextually situated analysis. We believe this method in film studies both reinforces the students' comprehension of the theoretical framework of an ethical topic, and casts light on its pertinence and limitations under the circumstances of the scene, thus proving a constructive tool to strengthen the bridge between the theoretical teaching of clinical ethics and clinical practice.
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Affiliation(s)
- Diego Real de Asúa
- Division of Medical Ethics, Department of Medicine, Weill Cornell Medical College, New York, NY, United States
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Plaza Francisco Morano S/N, 28005, Madrid, Spain
- Clinical Bioethics and Professionalism Working Group, Spanish Society of Internal Medicine, Madrid, Spain
- Department of Internal Medicine, Hospital Universitario de La Princesa, Madrid, Spain
| | - Karmele Olaciregui Dague
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Plaza Francisco Morano S/N, 28005, Madrid, Spain
- Epileptology Department, University Hospital Bonn, Bonn, Germany
| | - Andrés Arriaga
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Plaza Francisco Morano S/N, 28005, Madrid, Spain
| | - Benjamin Herreros
- Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Plaza Francisco Morano S/N, 28005, Madrid, Spain.
- Clinical Bioethics and Professionalism Working Group, Spanish Society of Internal Medicine, Madrid, Spain.
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24
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Villiger D, Trachsel M. With great power comes great vulnerability: an ethical analysis of psychedelics' therapeutic mechanisms proposed by the REBUS hypothesis. J Med Ethics 2023; 49:826-832. [PMID: 37045591 DOI: 10.1136/jme-2022-108816] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/03/2023] [Indexed: 06/19/2023]
Abstract
Psychedelics are experiencing a renaissance in mental healthcare. In recent years, more and more early phase trials on psychedelic-assisted therapy have been conducted, with promising results overall. However, ethical analyses of this rediscovered form of treatment remain rare. The present paper contributes to the ethical inquiry of psychedelic-assisted therapy by analysing the ethical implications of its therapeutic mechanisms proposed by the relaxed beliefs under psychedelics (REBUS) hypothesis. In short, the REBUS hypothesis states that psychedelics make rigid beliefs revisable by increasing the influence of bottom-up input. Put differently, patients become highly suggestible and sensitive to context during a psychedelic session, amplifying therapeutic influence and effects. Due to that, patients are more vulnerable in psychedelic-assisted therapy than in other therapeutic interventions; they lose control during a psychedelic session and become dependent on the therapeutic setting (including the therapist). This enhanced vulnerability is ethically relevant and has been exploited by some therapists in the past. Therefore, patients in current research settings and starting mainstream medical settings need to be well informed about psychedelics' mechanisms and their implications to give valid informed consent to treatment. Furthermore, other security measures are warranted to protect patients from the vulnerability coming with psychedelic-assisted therapy.
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Affiliation(s)
- Daniel Villiger
- Department of Philosophy, University of Zurich, Zurich, Switzerland
| | - Manuel Trachsel
- Clinical Ethics Unit of University Hospital Basel and Psychiatric University Clinics, Basel, Switzerland
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25
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Hardman D, Hutchinson P. Rules, practices and principles: Putting bioethical principles in their place. J Eval Clin Pract 2023; 29:1095-1099. [PMID: 37455328 DOI: 10.1111/jep.13898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 06/25/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Bioethics seems preoccupied with establishing, debating, promoting and sometimes debunking principles. While these tasks trade on the status of the word 'principle' in our ordinary language, scant attention is paid to the way principles operate in language. In this paper, we explore how principles relate to rules and practices so as to better understand their logic. We argue that principles gain their sense and power from the practices which give them sense. While general principles can be, and are, establishable in abstraction from specific practices, as they are in principlist bioethics, such principles are impotent as moral guides to action. We show that the purchase any principle has as a moral guide to action emerges from its indexical properties as a principle which has sense in a specific practice. The meaning of any principle is internal to the practice and context in which it is invoked and, therefore, principles are not kinds of master rule which dictate moral judgement in new contexts but rather chameleon-like rules which change with the contexture in which they are invoked.
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Affiliation(s)
- Doug Hardman
- Department of Psychology, Faculty of Science and Technology, University of Bournemouth, Poole, UK
| | - Phil Hutchinson
- Department of Psychology, Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
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26
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McMillan J. Generative AI and Ethical Analysis. Am J Bioeth 2023; 23:42-44. [PMID: 37812114 DOI: 10.1080/15265161.2023.2249852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
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27
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Armitage RC. Socially optimal dosing for scarce vaccines: Ethical analysis through the principlism framework. J Eval Clin Pract 2023; 29:1090-1094. [PMID: 37128128 DOI: 10.1111/jep.13850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/13/2023] [Indexed: 05/03/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Under conditions of vaccine scarcity, the socially optimal dosing (SOD) strategy administers a lower dose of vaccine to a larger number of people than the individually optimal dosing (IOD) strategy, which administers a higher dose of vaccine to a smaller number of people. In the context of vaccines that generate diminishing returns of effectiveness with each additional dose beyond the first, SOD therefore generates a greater total amount of vaccine-induced protection than IOD and, as such, constitutes the socially optimal strategy. While the clinical and public health arguments in favour of SOD have previously been outlined, this article conducts an ethical analysis of SOD for scarce vaccines through the ethical framework of principlism. METHODS SOD is examined with regard to each principle within the principlism framework-nonmaleficence, beneficence, autonomy, and justice. RESULTS SOD is found to satisfy each of the ethical requirements under examination. Regarding nonmaleficence, SOD induces less iatrogenic harm than IOD since the dose of vaccine administered to each individual is lower in the former than the latter. Furthermore, both the good and bad effects of SOD are foreseen while only the good effects are intended, meaning this strategy simultaneously satisfies the doctrine of double effect. Regarding autonomy, SOD makes vaccine-induced protection available to a greater number of individuals who wish to receive it, thereby respecting their capacity for self-determination and to make independent decisions. Regarding beneficence, SOD renders the good-namely the protection of health-more widely available to the individuals that constitute the population in question. Finally, SOD promotes theories of justice that treat individuals equally and is unlikely to reduce the effectiveness of other distribution policies that allocate scarce vaccines in a just manner. CONCLUSION In conditions of vaccine scarcity, SOD favourably satisfies the ethical framework of principlism.
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Affiliation(s)
- Richard C Armitage
- Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK
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28
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Alahmad B, AlMekhled D, Busalacchi K, Wang WC. In-Depth Ethical Analysis of the COVID-19 Vaccine Rollout for Migrant Workers in the Gulf Countries. Int J Soc Determinants Health Health Serv 2023; 53:488-493. [PMID: 37218178 PMCID: PMC10203856 DOI: 10.1177/27551938231177845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
During the initial COVID-19 vaccine rollout, supplies were scarce, necessitating rationing. Gulf countries, hosting millions of migrant workers, prioritized nationals over migrants for vaccination. As it turned out, many migrant workers found themselves waiting behind nationals to get vaccinated for COVID-19. Here, we discuss the public health ethical concerns surrounding this approach and call for fair and inclusive vaccine allocation policies. First, we examine global justice through the lens of statism, where distributive justice applies only to sovereign state members, and cosmopolitanism, advocating equal justice distribution for all humans. We propose a cooperativist perspective, suggesting that new justice obligations can arise between people beyond national ties. In cases of mutually beneficial cooperation, such as migrant workers contributing to a nation's economy, equal concern for all parties is required. Second, the principle of reciprocity further supports this stance, as migrants significantly contribute to host countries' societies and economies. Additional ethical principles-equity, utilitarianism, solidarity, and nondiscrimination-are essentially violated when excluding non-nationals in vaccine distribution. Finally, we argue that prioritizing nationals over migrants is not only ethically indefensible, but it also fails to ensure full protection for nationals and hampers efforts to curb COVID-19 community spread.
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Affiliation(s)
- Barrak Alahmad
- Department of Environmental Health, Harvard
T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Environmental & Occupational Health
Department, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait
- Dasman Diabetes Institute, Kuwait City,
Kuwait
| | - Dawoud AlMekhled
- Melbourne Medical School, Faculty of
Medicine, Dentistry, and Health Sciences, Melbourne University, Melbourne, Australia
| | - Katie Busalacchi
- Department of Social and Behavioral Sciences,
Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Wei-Chen Wang
- Department of Epidemiology, Harvard T.H. Chan
School of Public Health, Harvard University, Boston, MA, USA
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29
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de Kanter AFJ, Jongsma KR, Bouten CVC, Bredenoord AL. How Smart are Smart Materials? A Conceptual and Ethical Analysis of Smart Lifelike Materials for the Design of Regenerative Valve Implants. Sci Eng Ethics 2023; 29:33. [PMID: 37668955 PMCID: PMC10480256 DOI: 10.1007/s11948-023-00453-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Abstract
It may soon become possible not just to replace, but to re-grow healthy tissues after injury or disease, because of innovations in the field of Regenerative Medicine. One particularly promising innovation is a regenerative valve implant to treat people with heart valve disease. These implants are fabricated from so-called 'smart', 'lifelike' materials. Implanted inside a heart, these implants stimulate re-growth of a healthy, living heart valve. While the technological development advances, the ethical implications of this new technology are still unclear and a clear conceptual understanding of the notions 'smart' and 'lifelike' is currently lacking. In this paper, we explore the conceptual and ethical implications of the development of smart lifelike materials for the design of regenerative implants, by analysing heart valve implants as a showcase. In our conceptual analysis, we show that the materials are considered 'smart' because they can communicate with human tissues, and 'lifelike' because they are structurally similar to these tissues. This shows that regenerative valve implants become intimately integrated in the living tissues of the human body. As such, they manifest the ontological entanglement of body and technology. In our ethical analysis, we argue this is ethically significant in at least two ways: It exacerbates the irreversibility of the implantation procedure, and it might affect the embodied experience of the implant recipient. With our conceptual and ethical analysis, we aim to contribute to responsible development of smart lifelike materials and regenerative implants.
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Affiliation(s)
- Anne-Floor J de Kanter
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands.
| | - Karin R Jongsma
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
| | - Annelien L Bredenoord
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
- Erasmus School of Philosophy, Erasmus University Rotterdam, 3062 PA, Rotterdam, The Netherlands
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30
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Skuban-Eiseler T, Orzechowski M, Denkinger M, Kocar TD, Leinert C, Steger F. Artificial Intelligence-Based Clinical Decision Support Systems in Geriatrics: An Ethical Analysis. J Am Med Dir Assoc 2023; 24:1271-1276.e4. [PMID: 37453451 DOI: 10.1016/j.jamda.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES To provide an ethical analysis of the implications of the usage of artificial intelligence-supported clinical decision support systems (AI-CDSS) in geriatrics. DESIGN Ethical analysis based on the normative arguments regarding the use of AI-CDSS in geriatrics using a principle-based ethical framework. SETTING AND PARTICIPANTS Normative arguments identified in 29 articles on AI-CDSS in geriatrics. METHODS Our analysis is based on a literature search that was done to determine ethical arguments that are currently discussed regarding AI-CDSS. The relevant articles were subjected to a detailed qualitative analysis regarding the ethical considerations Supplementary Datamentioned therein. We then discussed the identified arguments within the frame of the 4 principles of medical ethics according to Beauchamp and Childress and with respect to the needs of frail older adults. RESULTS We found a total of 5089 articles; 29 articles met the inclusion criteria and were subsequently subjected to a detailed qualitative analysis. We could not identify any systematic analysis of the ethical implications of AI-CDSS in geriatrics. The ethical considerations are very unsystematic and scattered, and the existing literature has a predominantly technical focus emphasizing the technology's utility. In an extensive ethical analysis, we systematically discuss the ethical implications of the usage of AI-CDSS in geriatrics. CONCLUSIONS AND IMPLICATIONS AI-CDSS in geriatrics can be a great asset, especially when dealing with patients with cognitive disorders; however, from an ethical perspective, we see the need for further research. By using AI-CDSS, older patients' values and beliefs might be overlooked, and the quality of the doctor-patient relationship might be altered, endangering compliance to the 4 ethical principles of Beauchamp and Childress.
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Affiliation(s)
- Tobias Skuban-Eiseler
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany; kbo-Isar-Amper-Klinikum Region München, München-Haar, Germany.
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
| | - Michael Denkinger
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany; AGAPLESION Bethesda Clinic Ulm, Ulm, Germany
| | - Thomas Derya Kocar
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany; AGAPLESION Bethesda Clinic Ulm, Ulm, Germany
| | - Christoph Leinert
- Institute of Geriatric Research, Ulm University Medical Center, Ulm, Germany; AGAPLESION Bethesda Clinic Ulm, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
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Buruk B, Aytaç G. Ethical analysis of cadaver supply and usage processes for research within the scope of the Helsinki Declaration. Dev World Bioeth 2023; 23:211-219. [PMID: 35727160 DOI: 10.1111/dewb.12360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/18/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
Recent technological developments have considerably transformed the supply, storage, and transportation processes of cadavers, creating new and previously unforeseen ethical challenges regarding cadaver usage. In this study, we analyzed two aspects of the cadaver processing system-cadaver supply and its use in research. Thereafter, we highlighted the major ethical concerns underlying these stages and correlated our search results with the ethical principles outlined in the Declaration of Helsinki (DoH), or Helsinki Declaration. To ensure the reliability and continuity of medical progress, human-especially cadaver-research depends on the ethical priorities as outlined in the DoH: respect for autonomy, privacy/confidentiality, risks/burdens/benefits, and the protection of vulnerable groups. According to our ethics analysis, which also corresponds with the ethics guidelines of the Consensus Panel on Research with the Recently Dead, the most ignored values were respect for autonomy and privacy/confidentiality issues. Based on these ethical concerns, we provide recommendations to address these challenges in anatomy research.
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Merz JF. A response to Al et al. Trials 2023;24:233. Trials 2023; 24:525. [PMID: 37574550 PMCID: PMC10424340 DOI: 10.1186/s13063-023-07574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
In their recent paper, Al and colleagues (Trials 2023;24:233) argue that manipulation of the methods of recruitment using well-known techniques in order to increase enrollment can be ethically acceptable. This brief response challenges that notion as an affront to voluntariness and a devolution of the ethics of human subjects research to the "ethics" of the marketplace.
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Affiliation(s)
- Jon F Merz
- Department of Medical Ethics & Health Policy, Perelman School of Medicine at the University of Pennsylvania, Blockley Hall 1427, 423 Guardian Drive, Philadelphia, PA, 19104-4884, USA.
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Popa E, Zawiła-Niedźwiecki J, Zabdyr-Jamróz M. Policy change without ethical analysis? Commentary on the publication of Smajdor. Theor Med Bioeth 2023; 44:379-385. [PMID: 37420106 DOI: 10.1007/s11017-023-09631-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 07/09/2023]
Affiliation(s)
- Elena Popa
- Interdisciplinary Centre for Ethics, Jagiellonian University, Kraków, Poland.
| | | | - Michał Zabdyr-Jamróz
- Health Policy and Management Department, Institute of Public Health, Jagiellonian University Medical College, Kraków, Poland
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Montanari Vergallo G, Gulino M. Is whole-body gestational donation without explicit consent a valid alternative to surrogate motherhood? An ethical analysis through analogy reasoning and principlist approach. Theor Med Bioeth 2023; 44:387-391. [PMID: 37470913 DOI: 10.1007/s11017-023-09634-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Gianluca Montanari Vergallo
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, Viale Regina Elena, 336, 00161, Rome, Italy.
| | - Matteo Gulino
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
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35
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Kulkarni S, Flescher A, Ahmad M, Bayliss G, Bearl D, Biondi L, Davis E, George R, Gordon E, Lyons T, Wightman A, Ladin K. Ethical analysis examining the prioritisation of living donor transplantation in times of healthcare rationing. J Med Ethics 2023; 49:389-392. [PMID: 34983855 PMCID: PMC10314075 DOI: 10.1136/medethics-2021-107574] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/17/2021] [Indexed: 05/20/2023]
Abstract
The transplant community has faced unprecedented challenges balancing risks of performing living donor transplants during the COVID-19 pandemic with harms of temporarily suspending these procedures. Decisions regarding postponement of living donation stem from its designation as an elective procedure, this despite that the Centers for Medicare and Medicaid Services categorise transplant procedures as tier 3b (high medical urgency-do not postpone). In times of severe resource constraints, health systems may be operating under crisis or contingency standards of care. In this manuscript, the United Network for Organ Sharing Ethics Workgroup explores prioritisation of living donation where health systems operate under contingency standards of care and provide a framework with recommendations to the transplant community on how to approach living donation in these circumstances.To guide the transplant community in future decisions, this analysis suggests that: (1) living donor transplants represent an important option for individuals with end-stage liver and kidney disease and should not be suspended uniformly under contingency standards, (2) exposure risk to SARS-CoV-2 should be balanced with other risks, such as exposure risks at dialysis centres. Because many of these risks are not quantifiable, donors and recipients should be included in discussions on what constitutes acceptable risk, (3) transplant hospitals should strive to maintain a critical transplant workforce and avoid diverting expertise, which could negatively impact patient preparedness for transplant, (4) transplant hospitals should consider implementing protocols to ensure early detection of SARS-CoV-2 infections and discuss these measures with donors and recipients in a process of shared decision-making.
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Affiliation(s)
- Sanjay Kulkarni
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew Flescher
- Department of English, Stony Brook University, Stony Brook, New York, USA
| | - Mahwish Ahmad
- Center for Bioethics, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - George Bayliss
- Department of Medicine, Brown Univeristy School of Medicine, Providence, Rhode Island, USA
| | - David Bearl
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Lynsey Biondi
- Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | | | - Roshan George
- Department of Pediatrics, Emory Univeristy School of Medicine, Atlanta, Georgia, USA
| | - Elisa Gordon
- Department of Surgery, Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Tania Lyons
- UNOS Ethics Committee, Richmond, Virginia, USA
| | - Aaron Wightman
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Keren Ladin
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
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36
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Baugh CM, Glantz L, Mello MM. Decisions about College Football during Covid-19: An Ethical Analysis. J Law Med Ethics 2023; 51:104-118. [PMID: 37226745 PMCID: PMC10209992 DOI: 10.1017/jme.2023.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This manuscript uses competitive college football as a lens into the complexities of decision-making amid the Covid-19 pandemic. Pulling together what is known about the decision-makers, the decision-making processes, the social and political context, the risks and benefits, and the underlying obligations of institutions to these athletes, we conduct an ethical analysis of the decisions surrounding the 2020 fall football season. Based on this ethical analysis, we provide key recommendations to improve similar decision processes moving forward.
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Affiliation(s)
- Sydney L. Goldberg
- Northeastern University School of Law, Boston, MA, USA
- Mongan Institute Health Policy Research Center and Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Douglas E. Levy
- Mongan Institute Health Policy Research Center and Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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38
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Chaffer TJ. Future-like-ours as a metaphysical reductio ad absurdum argument of personal identity. Bioethics 2023; 37:367-373. [PMID: 36773306 DOI: 10.1111/bioe.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 06/18/2023]
Abstract
Don Marquis' future-like-ours account is regarded as the best secular anti-abortion position because he frames abortion as a wrongful killing via deprivation of a valuable future. Marquis objects to the reductio ad absurdum of contraception as being immoral because it is too difficult to identify an individual that is deprived of a future. To demonstrate why Marquis' treatment of the contraception reductio is flawed by his own future-like-ours line of reasoning, I offer an argument for why there is indeed a candidate for harm-the ovum-for it can be viewed as providing the functional foundation for a new life through (1) mitochondrial DNA inheritance, (2) paternal histone restructuring during fertilization, and (3) ability to initiate parthenogenesis. As evidenced by these distinct and natural features of ova, candidate (2) "some ovum or other" should be morally prioritized as the direct candidate for harm in the contraception reductio. By assessing the philosophical inconsistencies in Marquis' future-like-ours argument, this paper provides strong metaphysical grounds for rejecting the best secular anti-abortion position.
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Affiliation(s)
- Tomer Jordi Chaffer
- Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
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39
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Rocha IEGM, Fonseca FLBDES, Silva J. The care of the patients with hipoplastic left heart syndrome in places of social and economic vulneability. An ethical analysis. Rev Col Bras Cir 2023; 50:e20233437. [PMID: 37075465 PMCID: PMC10508666 DOI: 10.1590/0100-6991e-20233437-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/22/2022] [Indexed: 04/21/2023] Open
Abstract
The birth of a child means hope and joy, particularly for the parents and the healthcare team. When this child is born with a severe malformation and a poor prognosis, as in the case of hypoplastic left heart syndrome, the scenario is one of great uncertainty and emotional suffering. The role of the health team becomes fundamental for the identification of conflicts of values and for the search for shared decisions that promote the best benefit to the child. When the diagnosis is made during fetal life, it is necessary to develop counseling strategies appropriate to the context of each family. In places with limited care resources, precarious prenatal care and short temporal conditions, the recommended counseling is compromised. Indication of treatment requires technical competence and a detailed analysis of ethical issues, and consultation with institutional clinical bioethics services or commissions is important. The article proposes to address the moral conflicts of two clinical cases and the respective bioethical analysis that involves principles and values in contexts of vulnerability and uncertainty, contrasting two situations where the indication of treatment was based on accessibility to treatment.
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Affiliation(s)
- Isaura Elaine Gonçalves Moreira Rocha
- - Universidade Federal de Pernambuco, Programa de Pós-graduação em Cirurgia - Recife - PE -Brasil
- - Universidade Federal do Cariri, Faculdade de Medicina - Barbalha - CE - Brasil
| | | | - Josimário Silva
- - Universidade Federal de Pernambuco, Programa de Pós-graduação em Cirurgia - Recife - PE -Brasil
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40
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Biasetti P, Hildebrandt TB, Göritz F, Hermes R, Holtze S, Stejskal J, Galli C, Pollastri I, Muzzo A, Lekolool I, Ndereeh D, Omondi P, Kariuki L, Mijele D, Mutisya S, Ngulu S, de Mori B. Application of decision tools to ethical analysis in biodiversity conservation. Conserv Biol 2023; 37:e14029. [PMID: 36317722 DOI: 10.1111/cobi.14029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/10/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Achieving ethically responsible decisions is crucial for the success of biodiversity conservation projects. We adapted the ethical matrix, decision tree, and Bateson's cube to assist in the ethical analysis of complex conservation scenarios by structuring these tools so that they can implement the different value dimensions (environmental, social, and animal welfare) involved in conservation ethics. We then applied them to a case study relative to the decision-making process regarding whether or not to continue collecting biomaterial on the oldest of the two remaining northern white rhinoceroses (Ceratotherium simum cottoni), a functionally extinct subspecies of the white rhinoceros. We used the ethical matrix to gather ethical pros and cons and as a starting point for a participatory approach to ethical decision-making. We used decision trees to compare the different options at stake on the basis of a set of ethical desiderata. We used Bateson's cube to establish a threshold of ethical acceptability and model the results of a simple survey. The application of these tools proved to be pivotal in structuring the decision-making process and in helping reach a shared, reasoned, and transparent decision on the best option from an ethical point of view among those available.
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Affiliation(s)
- Pierfrancesco Biasetti
- Department of Reproduction Management, Leibniz Institute for Zoo and Wildlife Research, Berlin, Germany
- Ethics Laboratory for Veterinary Medicine, Conservation and Animal Welfare, Padua University, Padua, Italy
| | - Thomas B Hildebrandt
- Department of Reproduction Management, Leibniz Institute for Zoo and Wildlife Research, Berlin, Germany
- Department of Veterinary Medicine, Freie Universität, Berlin, Germany
| | - Frank Göritz
- Department of Reproduction Management, Leibniz Institute for Zoo and Wildlife Research, Berlin, Germany
| | - Robert Hermes
- Department of Reproduction Management, Leibniz Institute for Zoo and Wildlife Research, Berlin, Germany
| | - Susanne Holtze
- Department of Reproduction Management, Leibniz Institute for Zoo and Wildlife Research, Berlin, Germany
| | - Jan Stejskal
- ZOO Dvůr Králové, Králové nad Labem, Czech Republic
| | - Cesare Galli
- Avantea, Laboratory of Reproductive Technologies, Cremona, Italy
| | - Ilaria Pollastri
- Ethics Laboratory for Veterinary Medicine, Conservation and Animal Welfare, Padua University, Padua, Italy
- Department of Comparative Biomedicine and Food Science, University of Padua, Legnaro, Italy
| | - Alessia Muzzo
- Department of Comparative Biomedicine and Food Science, University of Padua, Legnaro, Italy
| | | | - David Ndereeh
- Wildlife Research and Training Institute, Karagita, Kenya
| | | | | | | | | | | | - Barbara de Mori
- Ethics Laboratory for Veterinary Medicine, Conservation and Animal Welfare, Padua University, Padua, Italy
- Department of Comparative Biomedicine and Food Science, University of Padua, Legnaro, Italy
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41
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Al P, Hey S, Weijer C, Gillies K, McCleary N, Yee ML, Inglis J, Presseau J, Brehaut J. Changing patient preferences toward better trial recruitment: an ethical analysis. Trials 2023; 24:233. [PMID: 36973759 PMCID: PMC10044713 DOI: 10.1186/s13063-023-07258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
While randomized controlled trials are essential to health research, many of these trials fail to recruit enough participants. Approaching recruitment through the lens of behavioral science can help trialists to understand influences on the decision to participate and use them to increase recruitment. Although this approach is promising, the use of behavioral influences during recruitment is in tension with the ethical principle of respect for persons, as at least some of these influences could be used to manipulate potential participants. In this paper, we examine this tension by discussing two types of behavioral influences: one example involves physician recommendations, and the other involves framing of information to exploit cognitive biases. We argue that despite the apparent tension with ethical principles, influencing trial participants through behavior change strategies can be ethically acceptable. However, we argue that trialists have a positive obligation to analyze their recruitment strategies for behavioral influences and disclose these upfront to the research ethics committee. But we also acknowledge that since neither trialists nor ethics committees are presently well equipped to perform these analyses, additional resources and guidance are needed. We close by outlining a path toward the development of such guidance.
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Affiliation(s)
- Pepijn Al
- Rotman Institute of Philosophy, Western University, London, ON, Canada.
| | - Spencer Hey
- Prism Analytic Technologies, Cambridge, MA, USA
| | - Charles Weijer
- Departments of Medicine, Epidemiology & Biostatistics, and Philosophy, Western University, London, ON, Canada
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nicola McCleary
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Juliette Inglis
- Patient partner, Montreal, QC, Canada
- Patient partner, Edmonton, AB, Canada
| | - Justin Presseau
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jamie Brehaut
- Centre for Implementation Research, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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42
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Newson AJ, Deans Z, Dive L, Holmes IC. Consistency of What? Appropriately Contextualizing Ethical Analysis of Non-Invasive Prenatal Testing. Am J Bioeth 2023; 23:56-58. [PMID: 36919553 DOI: 10.1080/15265161.2023.2169402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
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43
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Weber E, Wang Q. The structure of analogical reasoning in bioethics. Med Health Care Philos 2023; 26:69-84. [PMID: 36350535 DOI: 10.1007/s11019-022-10123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Casuistry, which involves analogical reasoning, is a popular methodological approach in bioethics. The method has its advantages and challenges, which are widely acknowledged. Meta-philosophical reflection on exactly how bioethical casuistry works and how the challenges can be addressed is limited. In this paper we propose a framework for structuring casuistry and analogical reasoning in bioethics. The framework is developed by incorporating theories and insights from the philosophy of science: Mary Hesse's ideas on horizontal and vertical relations in analogical reasoning in the sciences, Paul Bartha's articulation model of analogical reasoning and Daniel Steel's insights on mechanism-based extrapolation in biomedical research. Adopting our framework results in two practical benefits: it sets methodological standards for analogical reasoning and enables us to compare and evaluate diverging lines of analogical reasoning in a systematic way. Adopting the framework also has theoretical benefits: it helps to understand how analogical reasoning can have moral normativity; it pinpoints exactly where moral principles or theories enter analogical reasoning; and it helps to understand why casuistry is an attractive method in bioethics and in applied ethics more generally.
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Affiliation(s)
- Erik Weber
- Centre for Logic and Philosophy of Science, Ghent University (UGent), Blandijnberg 2, 9000, Ghent, Belgium.
| | - Qianru Wang
- Centre for Logic and Philosophy of Science, Ghent University (UGent), Blandijnberg 2, 9000, Ghent, Belgium
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44
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Martschenko DO, Callier SL, Garrison NA, Lee SSJ, Turley P, Meyer MN, Parens E. Wrestling with Public Input on an Ethical Analysis of Scientific Research. Hastings Cent Rep 2023; 53 Suppl 1:S50-S65. [PMID: 37079856 DOI: 10.1002/hast.1478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Bioethicists frequently call for empirical researchers to engage participants and community members in their research, but don't themselves typically engage community members in their normative research. In this article, we describe an effort to include members of the public in normative discussions about the risks, potential benefits, and ethical responsibilities of social and behavioral genomics (SBG) research. We reflect on what might-and might not- be gained from engaging the public in normative scholarship and on lessons learned about public perspectives on the risks and potential benefits of SBG research and the responsible conduct and communication of such research. We also provide procedural lessons for others in bioethics who are interested in engaging members of the public in their research.
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45
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Wall A, Testa G. Defining the Cause of Death and Vitality of Organs in the Ethical Analysis of Controlled Donation after Circulatory Death Procedures. The American Journal of Bioethics 2023; 23:35-38. [PMID: 36681920 DOI: 10.1080/15265161.2022.2159575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Anji Wall
- Baylor University Medical Center at Dallas
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46
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Berkman ER, Richardson KL, Clark JD, Dick AAS, Lewis-Newby M, Diekema DS, Wightman AG. An ethical analysis of obesity as a contraindication of pediatric kidney transplant candidacy. Pediatr Nephrol 2023; 38:345-356. [PMID: 35488137 DOI: 10.1007/s00467-022-05572-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 01/10/2023]
Abstract
The inclusion of body mass index (BMI) as a criterion for determining kidney transplant candidacy in children raises clinical and ethical challenges. Childhood obesity is on the rise and common among children with kidney failure. In addition, obesity is reported as an independent risk factor for the development of CKD and kidney failure. Resultantly, more children with obesity are anticipated to need kidney transplants. Most transplant centers around the world use high BMI as a relative or absolute contraindication for kidney transplant. However, use of obesity as a relative or absolute contraindication for pediatric kidney transplant is controversial. Empirical data demonstrating poorer outcomes following kidney transplant in obese pediatric patients are limited. In addition, pediatric obesity is distributed inequitably among groups. Unlike adults, most children lack independent agency to choose their food sources and exercise opportunities; they are dependent on their families for these choices. In this paper, we define childhood obesity and review (1) the association and impact of obesity on kidney disease and kidney transplant, (2) existing adult guidelines and rationale for using high BMI as a criterion for kidney transplant, (3) the prevalence of childhood obesity among children with kidney failure, and (4) the existing literature on obesity and pediatric kidney transplant outcomes. We then discuss ethical considerations related to the use of obesity as a criterion for kidney transplant.
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Affiliation(s)
- Emily R Berkman
- Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Kelsey L Richardson
- Division of Pediatric Nephrology, Oregon Health Sciences University, Portland, OR, USA
| | - Jonna D Clark
- Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
| | - André A S Dick
- Division of Transplantation, Section of Pediatric Transplantation, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Mithya Lewis-Newby
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
- Division of Cardiac Critical Care, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Douglas S Diekema
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
- Division of Pediatric Emergency Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Aaron G Wightman
- Division of Bioethics and Palliative Care Medicine, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA
- Division of Pediatric Nephrology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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47
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Nix HP, Largent EA, Taljaard M, Mitchell SL, Weijer C. Ethical analysis of vulnerabilities in cluster randomized trials involving people living with dementia in long-term care homes. J Am Geriatr Soc 2023; 71:588-598. [PMID: 36435175 PMCID: PMC9957897 DOI: 10.1111/jgs.18128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/27/2022] [Accepted: 10/29/2022] [Indexed: 11/28/2022]
Abstract
Cluster randomized trials (CRT) of non-pharmacological interventions are an important means of improving the quality of care and quality of life of people living with dementia (PLWD) in long-term care (LTC) homes. PLWD in LTC homes are, however, vulnerable in manifold ways. Therefore, researchers require guidance to ensure that the rights and welfare of PLWD are protected in the course of this valuable research. In this article, we introduce a framework for identifying vulnerabilities in randomized trials and apply it to three CRTs involving PLWD in LTC homes. CRTs may render PLWD in LTC homes vulnerable to three autonomy wrongs: inadequately informed consent, inadequately voluntary consent, and invasions of privacy; two welfare wrongs: risks of therapeutic procedure exceed potential benefits, and excessive risk of non-therapeutic procedures; and one justice wrong: unjust impact of research activities on care. We then discuss appropriate, feasible additional protections that can be implemented to mitigate vulnerability while preserving the scientific validity of the CRT. Corresponding additional protections that can be feasibly implemented include capacity assessments, substitute decision-makers, assent, insulation from LTC home employees during the consent process, patient advocates, utilizing LTC home employees for data collection, stakeholder engagement, additional supervision during study procedures, using caregivers to complete questionnaires by proxy, and gatekeeper permission. Reassuringly, many of these additional protections promote, rather than imperil, the scientific validity of these trials.
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Affiliation(s)
- Hayden P Nix
- Schulich School of Medicine & Dentistry, Western University, London, Canada
- Oxford Uehiro Center for Practical Ethics, Oxford University, Oxford, UK
| | - Emily A Largent
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Susan L Mitchell
- Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Charles Weijer
- Department of Medicine, Western University, London, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Canada
- Department of Philosophy, Western University, London, Canada
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48
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Clem S. The Problem of Clinical Deception and Why We Cannot Begin in the Middle. Hastings Cent Rep 2023; 53:28-29. [PMID: 36840333 DOI: 10.1002/hast.1456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
In this brief commentary, I offer an appreciative yet critical analysis of Abram Brummett and Erica Salter's article, "Mapping the Moral Terrain of Clinical Deception." I challenge the authors to clarify their choice of the term "deception" (as opposed to "lying" or "dishonesty"), and I explain how these different terms may affect one's moral analysis. I also draw attention to the authors' claim that veracity is the ethical default of clinicians. I argue that their failure to defend this claim renders their framework more limited in its usefulness than they seem to acknowledge. While their framework does an excellent job of identifying morally salient features of clinical deception, it cannot be used to measure the strength of justification for an act of deception apart from a normative conception of truthfulness.
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49
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Chiou PZ. HPV Primary and Co-testing: An Ethical Analysis Exploring the Role of Cytology in Cervical Cancer Screening and Management. J Allied Health 2023; 52:301-304. [PMID: 38036477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2023]
Abstract
With the advancement in our understanding of the causative agents involved with cancer, there has been a considerable amount of debate within the laboratory and cytology community regarding how best to screen for cervical cancer. This paper attempts to review the three different approaches to cervical cancer screening through the lens of the four facie prima principles of biomedical ethics, including the respect for autonomy, principle of beneficence, non-maleficence, and justice. Analyzing the debate on cervical cancer screening platforms through the lens of the four principles of biomedical ethics ensures a comprehensive examination of all facets of the discussion, including a review of not only benefits and harm but also ensures that the final policy is fair and respectful for all the stakeholders. The conclusion from the analysis favors the use of co-testing but also supports making HPV primary and Pap testing viable options, depending on the needs of the community, patients, and providers.
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Affiliation(s)
- Paul Z Chiou
- Dep. of Clinical Laboratory and Medical Imaging, Rutgers University, 65 Bergen Street, Suite 353D, Newark, NJ 07107, USA. Tel 973-972-3312.
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50
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Takaguchi K, Kappes A, Yearsley JM, Sawai T, Wilkinson DJC, Savulescu J. Personal ethical settings for driverless cars and the utility paradox: An ethical analysis of public attitudes in UK and Japan. PLoS One 2022; 17:e0275812. [PMID: 36378636 PMCID: PMC9665398 DOI: 10.1371/journal.pone.0275812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022] Open
Abstract
Driverless cars are predicted to dramatically reduce collisions and casualties on the roads. However, there has been controversy about how they should be programmed to respond in the event of an unavoidable collision. Should they aim to save the most lives, prioritise the lives of pedestrians, or occupants of the vehicle? Some have argued that driverless cars should all be programmed to minimise total casualties. While this would appear to have wide international public support, previous work has also suggested regional variation and public reluctance to purchase driverless cars with such a mandated ethical setting. The possibility that algorithms designed to minimise collision fatalities would lead to reduced consumer uptake of driverless cars and thereby to higher overall road deaths, represents a potential "utility paradox". To investigate this paradox further, we examined the views of the general public about driverless cars in two online surveys in the UK and Japan, examining the influence of choice of a "personal ethical setting" as well as of framing on hypothetical purchase decisions. The personal ethical setting would allow respondents to choose between a programme which would save the most lives, save occupants or save pedestrians. We found striking differences between UK and Japanese respondents. While a majority of UK respondents wished to buy driverless cars that prioritise the most lives or their family members' lives, Japanese survey participants preferred to save pedestrians. We observed reduced willingness to purchase driverless cars with a mandated ethical setting (compared to offering choice) in both countries. It appears that the public values relevant to programming of driverless cars differ between UK and Japan. The highest uptake of driverless cars in both countries can be achieved by providing a personal ethical setting. Since uptake of driverless cars (rather than specific algorithm used) is potentially the biggest factor in reducing in traffic related accidents, providing some choice of ethical settings may be optimal for driverless cars according to a range of plausible ethical theories.
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Affiliation(s)
- Kazuya Takaguchi
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
- The Department of Ethics, Kyoto University, Kyoto, Japan
| | | | | | - Tsutomu Sawai
- Graduate School of Humanities and Social Sciences, Hiroshima University, Hiroshima, Japan
- Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan
| | - Dominic J. C. Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
- John Radcliffe Hospital, Oxford, United Kingdom
- Murdoch Children’s Research Institute, Melbourne, Australia
- * E-mail:
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
- Melbourne Law School, Melbourne, Australia
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