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Rasmussen LM. New collaborative statement by bioethics journal editors on generative AI use. Account Res 2024; 31:1. [PMID: 37910077 DOI: 10.1080/08989621.2023.2276169] [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] [Received: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Lisa M Rasmussen
- Editor-in-Chief, Accountability in Research and Department of Philosophy, University of North Carolina at Charlotte
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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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Aramesh K. Population, abortion, contraception, and the relation between biopolitics, bioethics, and biolaw in Iran. Dev World Bioeth 2024; 24:129-134. [PMID: 36649588 DOI: 10.1111/dewb.12386] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 08/11/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 01/18/2023]
Abstract
The Islamic government of Iran recently passed and announced a new law titled "Rejuvenation of the Population and Protection of the Family." This legislation is a noteworthy example of biopolitics-influenced biolaw. In terms of abortion, contraception, prenatal screening, and population control, this law clearly contrasts with women's fundamental rights and freedoms and has significant health-related consequences for different sectors of the population. A historical review of the population policies of the Islamic Republic of Iran shows the occurrence of multiple abrupt and radical changes in such policies over the past four decades. This new law, promoted by religious biopolitics, is the most recent example, and places stringent limits on abortion. According to it, all decisions concerning abortion must be made in courts rather than in health clinics. Such courts are typically presided over by male religious scholars. This law also limits prenatal screening to the degree that will increase the rate of genetic defects, especially in the population's lower socioeconomic strata. By strictly limiting access to contraception, this law will increase the rate of unwanted pregnancies and sexually transmitted diseases. This paper argues that such an influence of biopolitics on biolaw contrasts with the principles of bioethics. Still, Iran's current institution of bioethics cannot address it effectively. Therefore, a new model of interaction between bioethics, biopolitics, and biolaw is needed to prevent the detrimental consequences of such pieces of legislation. Such a paradigm shift is demanded by the current "Woman, Life, Freedom" movement of the Iranian people.
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Kandlbinder AE. A critical view on using "life not worth living" in the bioethics of assisted reproduction. Med Health Care Philos 2024; 27:189-203. [PMID: 38363499 PMCID: PMC11076207 DOI: 10.1007/s11019-023-10191-7] [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: 12/27/2023] [Indexed: 02/17/2024]
Abstract
This paper critically engages with how life not worth living (LNWL) and cognate concepts are used in the field of beginning-of-life bioethics as the basis of arguments for morally requiring the application of preimplantation genetic diagnosis (PGD) and/or germline genome editing (GGE). It is argued that an objective conceptualization of LNWL is largely too unreliable in beginning-of-life cases for deriving decisive normative reasons that would constitute a moral duty on the part of intending parents. Subjective frameworks are found to be more suitable to determine LNWL, but they are not accessible in beginning-of-life cases because there is no subject yet. Conceptual and sociopolitical problems are additionally pointed out regarding the common usage of clear case exemplars. The paper concludes that a moral requirement for the usage of PGD and GGE cannot be derived from the conceptual base of LNWL, as strong reasons that can be reliably determined are required to limit reproductive freedom on moral grounds. Educated predictions on prospective well-being might still be useful regarding the determination of moral permissibility of PGD and/or GGE. It is suggested that due to the high significance of subjective experience in the normativity of beginning-of-life bioethics, the discipline is called to more actively realize the inclusion of people with disabilities. This regards for instance research design, citation practices, and language choices to increase the accessibility of societal debates on the reproductive ethics of genetic technologies.
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Affiliation(s)
- Agnes Elisabeth Kandlbinder
- PhD Researcher, URPP Human Reproduction Reloaded, High-Risk Sub-Project 4, Department of Philosophy, University of Zurich, Zollikerstrasse 115, 8008, Zurich, Switzerland.
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Martínez de la Ossa Sáenz-López R, Trujillo Caballero L. Reflections in bioethics key to the document "Clinical guidelines for the care of transsexual, transgender and diverse gender minors". An Pediatr (Barc) 2024; 100:e27. [PMID: 38582649 DOI: 10.1016/j.anpede.2024.03.024] [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] [Received: 04/09/2022] [Accepted: 04/29/2022] [Indexed: 04/08/2024] Open
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Baker R. Anchor bias, autonomy, and 20th-century bioethicists' blindness to racism. Bioethics 2024; 38:275-281. [PMID: 38165654 DOI: 10.1111/bioe.13258] [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: 08/27/2023] [Accepted: 12/14/2023] [Indexed: 01/04/2024]
Abstract
The central thesis of this article is that by anchoring bioethics' core conceptual armamentarium in a four-principled theory emphasizing autonomy and treating justice as a principle of allocation, theorists inadvertently biased 20th-century bioethical scholarship against addressing such subjects as ableism, anti-Black racism, classism, and other forms of discrimination, placing them outside of the scope of bioethics research and scholarship. It is also claimed that these scope limitations can be traced to the displacement of the nascent concept of respect for persons-a concept designed to address classist and racist discrimination-with the morally solipsistic concept of autonomy.
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Affiliation(s)
- Robert Baker
- Department of Philosophy, William D. William Emeritus Professor of Philosophy, Union College, Schenectady, New York, USA
- Bioethics Department, Lewis School of Health Sciences, Clarkson University, Capital Region Campus, Schenectady, New York
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Mintz KT, Cureton A. Disability Bioethics, Social Inclusion, and Whole-Eye Transplantation. Am J Bioeth 2024; 24:85-87. [PMID: 38635443 PMCID: PMC11034888 DOI: 10.1080/15265161.2024.2327884] [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] [Indexed: 04/20/2024]
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Crutchfield P, Scheall S. Abolishing morality in biomedical ethics. Bioethics 2024; 38:316-325. [PMID: 38367255 DOI: 10.1111/bioe.13275] [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: 08/22/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/19/2024]
Abstract
In biomedical ethics, there is widespread acceptance of moral realism, the view that moral claims express a proposition and that at least some of these propositions are true. Biomedical ethics is also in the business of attributing moral obligations, such as "S should do X." The problem, as we argue, is that against the background of moral realism, most of these attributions are erroneous or inaccurate. The typical obligation attribution issued by a biomedical ethicist fails to truly capture the person's actual obligations. We offer a novel argument for rife error in obligation attribution. The argument starts with the idea of an epistemic burden. Epistemic burdens are all of those epistemic obstacles one must surmount in order to achieve some aim. Epistemic burdens shape decision-making such that given two otherwise equal options, a person will choose the option that has the lesser of epistemic burdens. Epistemic burdens determine one's potential obligations and, conversely, their non-obligations. The problem for biomedical ethics is that ethicists have little to no access to others' epistemic burdens. Given this lack of access and the fact that epistemic burdens determine potential obligations, biomedical ethicists often can only attribute accurate obligations out of luck. This suggests that the practice of attributing obligations in biomedical ethics is rife with error. To resolve this widespread error, we argue that this practice should be abolished from the discourse of biomedical ethics.
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Affiliation(s)
- Parker Crutchfield
- Department of Medical Ethics, Humanities, and Law, Homer Stryker M.D. School of Medicine, Western Michigan University, Kalamazoo, Michigan, USA
| | - Scott Scheall
- College of Integrative Sciences and Arts, School of Applied Science and Arts, Arizona State University, Tempe, Arizona, USA
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Ehni HJ, Wiesing U. The Declaration of Helsinki in bioethics literature since the last revision in 2013. Bioethics 2024; 38:335-343. [PMID: 38367022 DOI: 10.1111/bioe.13270] [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: 09/18/2023] [Revised: 12/18/2023] [Accepted: 01/22/2024] [Indexed: 02/19/2024]
Abstract
The World Medical Association has announced that a new revision process of the Declaration of Helsinki has been started. This article will identify the criticisms that have been made in the bioethics literature, particularly since the last revision. In addition, criticisms are discussed that were made in the literature even before the last revision and have not fallen silent. The plausibility of the recommendation for a change in the Declaration of Helsinki is examined.
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Affiliation(s)
- Hans-Jörg Ehni
- Institut für Ethik und Geschichte der Medizin, Universität Tübingen, Tübingen, Germany
| | - Urban Wiesing
- Institut für Ethik und Geschichte der Medizin, Universität Tübingen, Tübingen, Germany
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García Aguilera MF, García Méndez N, Muñoz EÁ, Lagarda Cuevas J. Letter to the editor on «Bioethical challenges in clinical practice of the 20th century». Rev Clin Esp 2024; 224:331-332. [PMID: 38521151 DOI: 10.1016/j.rceng.2024.03.004] [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: 03/25/2024]
Affiliation(s)
- María Fernanda García Aguilera
- Universidad de La Frontera, Doctorado en Ciencias Médicas, Temuco, Chile; Núcleo Milenio de Sociomedicina (SocioMed), Chile
| | - Nayely García Méndez
- Universidad de La Frontera, Doctorado en Ciencias Médicas, Temuco, Chile; Núcleo Milenio de Sociomedicina (SocioMed), Chile.
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11
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Celie KB, Mocharnuk JW, Kanmounye US, Ayala R, Banu T, Lakhoo K. The importance of global bioethics to paediatric health care. Lancet Child Adolesc Health 2024; 8:379-384. [PMID: 38408455 DOI: 10.1016/s2352-4642(23)00317-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 02/28/2024]
Abstract
The paradigm of values adopted by the global health community has a palpable, albeit often unseen, impact on patient health care. In this Viewpoint, we investigate an inherent tension in the core values of medical ethics and clinical practice that could explain why paediatric health care faces resource constraints despite compelling economic and societal imperatives to prioritise child health and wellbeing. The dominant narrative in the philosophy of medicine tends to disproportionately underscore values of independence and self-determination, which becomes problematic in the context of paediatric patients, who by their very nature epitomise vulnerability and dependence. A double-jeopardy situation arises when disadvantaged children see their inherent dependence leveraged against them. We illustrate this predicament through specific examples relating to rights and obligations and to autonomy. Alternative value perspectives-communitarianism and relational autonomy-might offer more robust protection for vulnerable children. A shift away from the dominant narrative towards a more explicit and inclusive discussion of values is necessary. Such a shift requires giving a legitimate platform to diverse perspectives, with the presumption that collective moral progress is possible; this endeavour is embodied by global bioethics. Successful implementation of global bioethics, in turn, hinges on close collaboration between practicing clinicians and bioethicists. Taking global bioethics seriously and actively pursuing collaboration could help the global health community achieve more equitable health care.
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Affiliation(s)
- Karel-Bart Celie
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK; Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Operation Smile, Department of Policy and Advocacy, Virginia Beach, VA, USA.
| | | | - Ulrick S Kanmounye
- Operation Smile, Department of Policy and Advocacy, Virginia Beach, VA, USA
| | - Ruben Ayala
- Operation Smile, Department of Policy and Advocacy, Virginia Beach, VA, USA
| | - Tahmina Banu
- Chittagong Research institute for Children Surgery, Chittagong, Bangladesh; Global Initiative for Children's Surgery, Sacramento, CA, USA
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Global Initiative for Children's Surgery, Sacramento, CA, USA
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Turner K, Kemp CL, Lesandrini J, Madison B, Donohue E. Bioethics in Gerontology: Developing a Typology of Ethical Issues in Assisted Living. J Appl Gerontol 2024; 43:520-526. [PMID: 37982692 DOI: 10.1177/07334648231211471] [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] [Indexed: 11/21/2023] Open
Abstract
Assisted living (AL) simultaneously is home to older adults who cannot live independently and a place where people work and visit and, therefore, where value conflicts are apt to arise. In this report we present the "Typology of Ethical Issues in Assisted Living" with emphasis on its development. The typology derives from a synthesis of frameworks used in acute care spaces adapted and applied to data collected as part of an ethnographic study involving AL residents with dementia. Our work advances knowledge and has implications for future research and practice.
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Affiliation(s)
- Kelly Turner
- Department of Health Care Ethics, Saint Louis University, Saint Louis, MO, USA
- Department of Ethics, Advance Care Planning, and Spiritual Health, WellStar Health System, Atlanta, GA, USA
| | - Candace L Kemp
- The Gerontology Institute, Georgia State University, Atlanta, GA, USA
- Department of Sociology, Georgia State University, Atlanta, GA, USA
| | - Jason Lesandrini
- Department of Ethics, Advance Care Planning, and Spiritual Health, WellStar Health System, Atlanta, GA, USA
| | - Barquiesha Madison
- Department of Ethics, Advance Care Planning, and Spiritual Health, WellStar Health System, Atlanta, GA, USA
| | - Erin Donohue
- The Gerontology Institute, Georgia State University, Atlanta, GA, USA
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Shaw J, Ali J, Atuire CA, Cheah PY, Español AG, Gichoya JW, Hunt A, Jjingo D, Littler K, Paolotti D, Vayena E. Research ethics and artificial intelligence for global health: perspectives from the global forum on bioethics in research. BMC Med Ethics 2024; 25:46. [PMID: 38637857 PMCID: PMC11025232 DOI: 10.1186/s12910-024-01044-w] [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: 10/31/2023] [Accepted: 04/01/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. METHODS The GFBR is an annual meeting organized by the World Health Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was "Ethics of AI in Global Health Research". The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022. RESULTS We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships. CONCLUSIONS The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research.
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Affiliation(s)
- James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Joseph Ali
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Caesar A Atuire
- Department of Philosophy and Classics, University of Ghana, Legon-Accra, Ghana
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | - Judy Wawira Gichoya
- Department of Radiology and Informatics, Emory University School of Medicine, Atlanta, GA, USA
| | - Adrienne Hunt
- Health Ethics & Governance Unit, Research for Health Department, Science Division, World Health Organization, Geneva, Switzerland
| | - Daudi Jjingo
- African Center of Excellence in Bioinformatics and Data Intensive Science, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Katherine Littler
- Health Ethics & Governance Unit, Research for Health Department, Science Division, World Health Organization, Geneva, Switzerland
| | | | - Effy Vayena
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
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Villalba A, Rueda J, de Miguel Beriain Í. Human stem-cell-derived embryo models: When bioethical normativity meets biological ontology. Dev Biol 2024; 508:88-92. [PMID: 38286184 DOI: 10.1016/j.ydbio.2024.01.009] [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] [Received: 01/02/2024] [Accepted: 01/21/2024] [Indexed: 01/31/2024]
Abstract
The use of human stem-cell-derived embryo models in biomedical research has recently sparked intense bioethical debates. In this article, we delve into the ethical complexities surrounding these models and advocate for a deeper exploration of their biological ontology to discuss their bioethical normativity. We examine the ethical considerations arising from the implementation of these models, emphasizing varying viewpoints on their ethical standing and the ethical obligations associated with their development and utilization. We contend that a nuanced comprehension of their biological ontology is crucial for navigating these ethical quandaries. Furthermore, we underscore the indispensability of interdisciplinary cooperation among bioethicists, biologists, and philosophers to unravel the complex interplay between biological ontology and the normative framework of bioethics. Moreover, this article introduces a novel combinatorial approach to resolve the ethical dilemma surrounding these models. We propose a distinction between models that closely emulate natural embryos, based on the status of synthetic embryos, and those capable of reproducing specific dimensions of embryonic development. Such differentiation allows for nuanced ethical considerations while harnessing the value of these models in scientific research, paving the way for a more comprehensive ethical framework in the context of evolving biotechnologies.
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Affiliation(s)
- Adrian Villalba
- Institut Cochin, INSERM, CNRS, Université Paris Cité, Paris, France; Department of Philosophy I, University of Granada, Spain.
| | - Jon Rueda
- Department of Philosophy I, University of Granada, Spain; Institute for Practical Ethics, University of California-San Diego, USA
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Shamsi-Gooshki E. Challenges of Bioethics Frameworks for Non-Democratic Contexts. Am J Bioeth 2024; 24:105-107. [PMID: 38529990 DOI: 10.1080/15265161.2024.2308146] [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: 03/27/2024]
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Avci E. A Framework for Examining Bioethical Issues from a Sunni Perspective: Maslaha. J Relig Health 2024; 63:1214-1229. [PMID: 36648579 DOI: 10.1007/s10943-023-01738-2] [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] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
All religions should develop convincing responses to emerging bioethical problems stemming from medical and technological advancements. Additionally, believers need to know their faiths' interpretations of bioethical issues to be able to make medical decisions in line with their religious values. Therefore, Islamic bioethics should provide Muslims with conclusive and credible answers regarding newly rising problems in health care by revisiting the religious norms and decrees. However, the diversity in the Islamic denominations, the traditionalist aspect of the Sunni jurisprudence demanding strict compliance with the scriptural texts, the lack of unanimously accepted authority, and the limited number of academic works in Islamic bioethics (at least in English) complicate exploring new standards or rules for new ethical matters. In this view, the present paper aims to delineate two primary Islamic theological schools and propose al-Ghazali's maslaha as a general framework to analyze bioethical issues in the Sunni tradition. Maslaha allows exercising discretion in light of the protection of five fundamental values: religion, life, reason, lineage, and property. Maslaha has the potential to enable Sunni Muslims to appraise contemporary ethical questions, concerns, and dilemmas through an Islamic view and make more autonomous decisions by having religious guidelines.
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Affiliation(s)
- Ercan Avci
- Grefenstette Center for Ethics, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA.
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Jecker NS, Atuire C, Ravitsky V, Ghaly M, Bélisle-Pipon JC. The Ethics of International Bioethics Conferencing: Continuing the Conversation. Am J Bioeth 2024; 24:W1-W7. [PMID: 38529986 DOI: 10.1080/15265161.2024.2316530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Nancy S Jecker
- University of Washington
- University of Johannesburg
- Chinese University of Hong Kong
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Shevchenko S, Zhavoronkov A. The Role of Exceptionalism in the Evolution of Bioethical Regulation. Camb Q Healthc Ethics 2024; 33:185-197. [PMID: 37288492 DOI: 10.1017/s0963180123000336] [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] [Indexed: 06/09/2023]
Abstract
The paper aims to present a critical analysis of the phenomenon and notion of exceptionalism in bioethics. The authors demonstrate that exceptionalism pertains to phenomena that are not (yet) entirely familiar to us and could potentially bear risks regarding their regulation. After an overview of the state of the art, we briefly describe the origins and evolution of the concept, compared to exception and exclusion. In the second step, they look at the overall development debates on genetic exceptionalism, compared to other bioethical debates on exceptionalism, before presenting a detailed analysis of a specific case of early regulation of genetic screening. In the last part, the authors explain the historical background behind the connection between exceptionalism and exclusion in these debates. Their main conclusion is that while the initial stage of the discussion is shaped by the concept of exceptionalism and awareness of risks of exclusion, the later development centers around exceptions that are needed in detailed regulatory procedures.
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Affiliation(s)
| | - Alexey Zhavoronkov
- Institut für Philosophie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
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Schütz M. Strategic Ambiguity: The Pragmatic Utopianism of Daniel Callahan's " Bioethics as a Discipline". Camb Q Healthc Ethics 2024; 33:167-173. [PMID: 37605984 DOI: 10.1017/s0963180123000440] [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] [Indexed: 08/23/2023]
Abstract
This article highlights the continuing relevance of a classic bioethical text, "Bioethics as a Discipline," published by the Hastings Center's cofounder Daniel Callahan in 1973. Connecting the text's programmatic recommendations with later reflections and interventions Callahan wrote about the development of bioethics illuminates how the vision Callahan established and the reality this vision helped create were interrelated-just not in the way Callahan had hoped for. Although this portrait relies on an individual perception of the development of bioethics, it might nevertheless, through its unique linkage of different bioethical temporalities, contribute to a broader reassessment of what bioethics became and why.
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Affiliation(s)
- Mathias Schütz
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-Universität München, Munich, Federal Republic of Germany
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Shai A. Standing for Democracy - Bioethics Conferences and Totalitarian Regimens. Am J Bioeth 2024; 24:46-48. [PMID: 38529975 DOI: 10.1080/15265161.2024.2308139] [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] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Ayelet Shai
- Technion Israel Institute of Technology
- Rambam Health Care Campus
- University of Haifa
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Viaña JNM. Interrogating Sites of Knowledge Production: The Role of Journals, Institutions, and Professional Societies in Advancing Epistemic Justice in Bioethics. Am J Bioeth 2024; 24:63-66. [PMID: 38529993 DOI: 10.1080/15265161.2024.2308144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
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Fins JJ. Baseball and Bioethics Revisited: The Pitch Clock and Age Discrimination in a Timeless Pastime. Camb Q Healthc Ethics 2024; 33:267-270. [PMID: 37767653 DOI: 10.1017/s096318012300049x] [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] [Indexed: 09/29/2023]
Abstract
In this essay, the author reflects on a decade's old essay on baseball and bioethics inspired by a conversation with the late David Thomasma. In a reprise of his earlier paper, Fins worries that modernity has come to baseball with the advent of the pitch clock and that this innovation brings age discrimination to a timeless pastime.
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Affiliation(s)
- Joseph J Fins
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY, USA
- Solomon Center for Health Law & Policy, Yale Law School, New Haven, CT, USA
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Bublitz JC. What an International Declaration on Neurotechnologies and Human Rights Could Look like: Ideas, Suggestions, Desiderata. AJOB Neurosci 2024; 15:96-112. [PMID: 37921859 DOI: 10.1080/21507740.2023.2270512] [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] [Indexed: 11/04/2023]
Abstract
International institutions such as UNESCO are deliberating on a new standard setting instrument for neurotechnologies. This will likely lead to the adoption of a soft law document which will be the first global document specifically tailored to neurotechnologies, setting the tone for further international or domestic regulations. While some stakeholders have been consulted, these developments have so far evaded the broader attention of the neuroscience, neurotech, and neuroethics communities. To initiate a broader debate, this target article puts to discussion twenty-five considerations and desiderata for recognition by a future instrument. They are formulated at different levels of abstraction, from the big picture to technical details, seek to widen the perspective of preparatory reports and transcend the narrow debate about "neurorights" which overshadows many richer and more relevant aspects. These desiderata are not an exhaustive enumeration but a starting point for discussions about what deserves and what requires protection by an international instrument.
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Jecker NS, Ravitsky V, Ghaly M, Bélisle-Pipon JC, Atuire C. Proposed Principles for International Bioethics Conferencing: Anti-Discriminatory, Global, and Inclusive. Am J Bioeth 2024; 24:13-28. [PMID: 37549186 DOI: 10.1080/15265161.2023.2232748] [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: 08/09/2023]
Abstract
This paper opens a critical conversation about the ethics of international bioethics conferencing and proposes principles that commit to being anti-discriminatory, global, and inclusive. We launch this conversation in the Section, Case Study, with a case example involving the International Association of Bioethics' (IAB's) selection of Qatar to host the 2024 World Congress of Bioethics. IAB's choice of Qatar sparked controversy. We believe it also may reveal deeper issues of Islamophobia in bioethics. The Section, Principles for International Bioethics Conferencing, sets forth and defends proposed principles for international bioethics conferencing. The Section, Applying Principles to Site Selection applies the proposed principles to the case example. The Section, Applying Principles Beyond Site Selection addresses other applications of the proposed principles. The Section, Objections responds to objections. We close (in the Section, Conclusion) by calling for a wider discussion of our proposed principles. One-Sentence Capsule Summary: How should bioethicists navigate the ethics of global bioethics conferencing?
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Affiliation(s)
- Nancy S Jecker
- University of Washington School of Medicine, Seattle, WA, USA
- University of Johannesburg, Auckland Park, South Africa
- Chinese University of Hong Kong, Hong Kong, China
| | - Vardit Ravitsky
- University of Montreal, Montreal, Canada
- Harvard Medical School, Boston, MA, USA
| | | | | | - Caesar Atuire
- University of Oxford, Oxford, England
- University of Ghana, Legon, Ghana
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Savulescu J. Two Models of Bioethics. Am J Bioeth 2024; 24:37-38. [PMID: 38529974 DOI: 10.1080/15265161.2024.2312765] [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: 03/27/2024]
Affiliation(s)
- Julian Savulescu
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore
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Rydenfelt H. Pragmatism and Experimental Bioethics. Camb Q Healthc Ethics 2024; 33:174-184. [PMID: 37332165 DOI: 10.1017/s0963180123000282] [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] [Indexed: 06/20/2023]
Abstract
Pragmatism gained considerable attention in bioethical discussions in the early 21st century. However, some dimensions and contributions of pragmatism to bioethics remain underexplored in both research and practice. It is argued that pragmatism can make a distinctive contribution to bioethics through its concept, developed by Charles S. Peirce and John Dewey, that ethical issues can be resolved through experimental inquiry. Dewey's proposal that policies can be confirmed or disconfirmed through experimentation is developed by comparing it to the confirmation of scientific hypotheses, with a focus on the objection that the consequences of following a moral view or policy do not provide guidance on choosing among competing ethical perspectives. As confirmation of scientific hypotheses typically relies on evidence gathered from observation, the possibility of ethically relevant observation is then explored based on Peirce's views on feelings as emotional interpretants. Finally, the connection between Dewey's experimental ethics and democracy is outlined and compared to unfettered ethical progressivism.
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Affiliation(s)
- Henrik Rydenfelt
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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Abstract
The question that this paper tries to answer is Q: "Can good academic bioethics be done without commitment to moral theory?" It is argued that the answer to Q is an unequivocal "Yes" for most of what we could call "critical bioethics," that is, the kind of bioethics work that primarily criticizes positions or arguments already in the literature or put forward by policymakers. The answer is also "Yes" for much of empirical bioethics. The second part of the paper then provides an analysis of Q in relation to "constructive bioethics," that is, bioethics work aimed at providing an argument for a particular position. In this part, it is argued that a number of the approaches or methods used that initially look like they involve no commitment to moral theory, nevertheless, involve such a commitment. This is shown to be the case for reflective equilibrium, mid-level theory, the use of theory fragments, and argument by analogy.
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Affiliation(s)
- Søren Holm
- Centre for Social Ethics and Policy, Department of Law, University of Manchester, Manchester, UK
- Center for Medical Ethics, HELSAM, Faculty of Medicine, University of Oslo, Oslo, Norway
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Blackshaw BP, Rodger D, Hurst DJ. Zooming in on Justice: The Case for Virtual Bioethics Conferencing. Am J Bioeth 2024; 24:60-62. [PMID: 38529970 DOI: 10.1080/15265161.2024.2308143] [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: 03/27/2024]
Affiliation(s)
| | - Daniel Rodger
- London South Bank University
- Birkbeck University of London
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Jecker NS, Savulescu J, Caplan A, Capron A, McMillan J, Ghaly M, Ortiz Millán G, Atuire C, McMahan J, Chuan VT, Bélisle-Pipon JC, Viswani V, Ravitsky V. Bioethics' Duty to Conference in Qatar: Reply to Magnus. Am J Bioeth 2024; 24:4-7. [PMID: 38529964 DOI: 10.1080/15265161.2024.2326363] [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: 03/27/2024]
Affiliation(s)
- Nancy S Jecker
- University of Washington School of Medicine
- University of Johannesburg
- Chinese University of Hong Kong
| | | | | | | | | | | | | | | | | | | | | | | | - Vardit Ravitsky
- The Hastings Center
- Harvard Medical School, Department of Global Health and Social Medicine
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Haidar H, Affdal A. International Bioethics Conferencing: "Can the Subaltern Speak?". Am J Bioeth 2024; 24:50-52. [PMID: 38529980 DOI: 10.1080/15265161.2024.2308136] [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: 03/27/2024]
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van der Linden RR, Schermer MHN. Exploring health and disease concepts in healthcare practice: an empirical philosophy of medicine study. BMC Med Ethics 2024; 25:38. [PMID: 38539209 PMCID: PMC10967067 DOI: 10.1186/s12910-024-01037-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024] Open
Abstract
In line with recent proposals for experimental philosophy and philosophy of science in practice, we propose that the philosophy of medicine could benefit from incorporating empirical research, just as bioethics has. In this paper, we therefore take first steps towards the development of an empirical philosophy of medicine, that includes investigating practical and moral dimensions. This qualitative study gives insight into the views and experiences of a group of various medical professionals and patient representatives regarding the conceptualization of health and disease concepts in practice and the possible problems that surround them. This includes clinical, epistemological, and ethical issues. We have conducted qualitative interviews with a broad range of participants (n = 17), working in various health-related disciplines, fields and organizations. From the interviews, we highlight several different practical functions of definitions of health and disease. Furthermore, we discuss 5 types of problematic situations that emerged from the interviews and analyze the underlying conceptual issues. By providing theoretical frameworks and conceptual tools, and by suggesting conceptual changes or adaptations, philosophers might be able to help solve some of these problems. This empirical-philosophical study contributes to a more pragmatic way of understanding the relevance of conceptualizing health and disease by connecting the participants' views and experiences to the theoretical debate. Going back and forth between theory and practice will likely result in a more complex but hopefully also better and more fruitful understanding of health and disease concepts.
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Affiliation(s)
- Rik R van der Linden
- department of Medical Ethics, Philosophy & History of Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - Maartje H N Schermer
- department of Medical Ethics, Philosophy & History of Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Shewmon DA. The Fundamental Concept of Death-Controversies and Clinical Relevance: The UDDA Revision Series. Neurology 2024; 102:e209196. [PMID: 38408293 DOI: 10.1212/wnl.0000000000209196] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/18/2023] [Indexed: 02/28/2024] Open
Abstract
When the Uniform Law Commission (ULC) was recently in the process of revising the Uniform Determination of Death Act (UDDA), Neurology® ran a series of debates over certain controversial issues being deliberated. Omitted was a debate over the fundamental concept underlying brain death. In his introductory article, Bernat offered reasons for this omission: "It is not directly relevant to practicing neurologists who largely accept brain death, do not question its conceptual basis, …." In this article I argue the opposite: the fundamental concept of death is highly relevant to the clinical criteria and tests used to diagnose it. Moreover, most neurologists in fact disagree with the conceptual basis articulated by Bernat. Basically, there are 3 competing concepts of death: (1) biological: cessation of the integrative unity of the organism as a whole (endorsed by Bernat and the 1981 President's Commission), (2) psychological: cessation of the person, equated with a self-conscious mind (endorsed by half of neurologists), and (3) the vital work concept proposed by the 2008 President's Council on Bioethics. The first actually corresponds to a circulatory, not a neurologic, criterion. The second corresponds to a "higher brain" criterion. The third corresponds loosely to the UK's "brainstem death" criterion. In terms of the biological concept, current diagnostic guidelines entail a high rate of false-positive declarations of death, whereas in terms of the psychological concept, the same guidelines entail a high rate of false-negative declarations. Brainstem reflexes have nothing to do with any death concept (their role is putatively to guarantee irreversibility). By shining a spotlight on the deficiencies of the UDDA through attempting to revise it, the ULC may have unwittingly opened a Pandora's box of fresh scrutiny of the concept of death underlying the neurologic criterion-particularly on the part of state legislatures with irreconcilably opposed worldviews.
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Affiliation(s)
- D Alan Shewmon
- From the Departments of Neurology and Pediatrics, David Geffen School of Medicine at UCLA
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Thangavelu PD, Janakiraman B, Pawar R, Shingare PH, Bhosale S, Souza RD, Duarte I, Nunes R. Understanding, being, and doing of bioethics; a state-level cross-sectional study of knowledge, attitude, and practice among healthcare professionals. BMC Med Ethics 2024; 25:30. [PMID: 38500167 PMCID: PMC10949768 DOI: 10.1186/s12910-024-01028-w] [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: 08/16/2023] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The field of bioethics examines the moral and ethical dilemmas that arise in the biological sciences, healthcare, and medical practices. There has been a rise in medical negligence cases, complaints against healthcare workers, and public dissatisfaction with healthcare professionals, according to reports from the Indian Medical Council and other healthcare associations. We intend to assess the level of knowledge, attitude, and practice of bioethics among the registered healthcare professionals (HCPs) of Maharashtra, India. METHODS A State-level online survey was conducted among the registered HCPs (n = 2143) casing all five regions of the Maharashtra state using a pre-tested self-administered questionnaire. The responses were expressed as mean, and proportions with their standard deviation and 95% CI respectively. Binary logistic regression and a multivariate logistic model were used to determine factors associated with knowledge, attitude, and practice of bioethics. RESULTS Of the 2143 registered HCPs in Maharashtra included in this study, most of them (65.2%) had adequate knowledge of bioethics. Adequate knowledge was associated with lower age, profession (nurses and dentists), employment in the private sector, HCPS at Marathwada and Pune, and higher educational attainment. About 3 in 5 HCPs (59.4%) had a favorable attitude towards the ethical practice of bioethics, and was associated with profession, place of work, region of practice, and work experience. The distribution of unethical bioethics practices among 10 items was proportionally high, and only 34.4% reported good/fair practice. The common unethical practices in the state were allowing patients to be examined by interns, and not informing them about professional misconduct to the regulatory bodies. CONCLUSION Most HCPs had adequate knowledge of bioethics, which is encouraging and would favor the laying foundation for forming a good bioethics framework. Only 3/5 HCPs demonstrated a favorable attitude, and the observed unethical practice is alarmingly common. A serious consideration to evaluate the compliance level of bioethics practice periodically and measures to educate, sensitize, and train bioethics among HCPs in Maharashtra is warranted.
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Affiliation(s)
- Poovishnu Devi Thangavelu
- Center of Bioethics, Faculty of Medicine, University of Porto, Porto, Portugal.
- Krishna College of Physiotherapy, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, 415539, India.
- International Chair in Bioethics, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, 415539, India.
| | - Balamurugan Janakiraman
- SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology (SRMIST), Kattankulathur, Tamil Nadu, 603203, India
| | - Renuka Pawar
- International Chair in Bioethics, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, 415539, India
- School of Dental Sciences, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, 415539, India
| | - Pravin H Shingare
- Pro Chancellor, Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, 415539, India
| | - Suresh Bhosale
- Krishna Vishwa Vidyapeeth (Deemed to be University), Karad, Maharashtra, 415539, India
| | - Russel D Souza
- International Institute of Organizational Psychological Medicine, Melbourne, Australia
| | - Ivone Duarte
- Center of Bioethics, Faculty of Medicine, University of Porto, Porto, Portugal
- Center of Bioethics, Faculty of Medicine, and MEDCIDS - Department of Community Medicine, Information and Decision in Health; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Nunes
- Center of Bioethics, Faculty of Medicine, University of Porto, Porto, Portugal
- Center of Bioethics, Faculty of Medicine, and MEDCIDS - Department of Community Medicine, Information and Decision in Health; Faculty of Medicine, University of Porto, Porto, Portugal
- Center of Bioethics, Faculty of Medicine, University of Porto, Porto, Portugal
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Charlton V, DiStefano M. An empirical ethics study of the coherence of NICE technology appraisal policy and its implications for moral justification. BMC Med Ethics 2024; 25:28. [PMID: 38448909 PMCID: PMC10918908 DOI: 10.1186/s12910-024-01016-0] [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: 08/09/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND As the UK's main healthcare priority-setter, the National Institute for Health and Care Excellence (NICE) has good reason to want to demonstrate that its decisions are morally justified. In doing so, it has tended to rely on the moral plausibility of its principle of cost-effectiveness and the assertion that it has adopted a fair procedure. But neither approach provides wholly satisfactory grounds for morally defending NICE's decisions. In this study we adopt a complementary approach, based on the proposition that a priority-setter's claim to moral justification can be assessed, in part, based on the coherence of its approach and that the reliability of any such claim is undermined by the presence of dissonance within its moral system. This study is the first to empirically assess the coherence of NICE's formal approach and in doing so to generate evidence-based conclusions about the extent to which this approach is morally justified. METHODS The study is grounded in the theory, methods and standards of empirical bioethics. Twenty NICE policy documents were coded to identify and classify the normative commitments contained within NICE technology appraisal policy as of 31 December 2021. Coherence was systematically assessed by attempting to bring these commitments into narrow reflective equilibrium (NRE) and by identifying sources of dissonance. FINDINGS Much of NICE policy rests on coherent values that provide a strong foundation for morally justified decision-making. However, NICE's formal approach also contains several instances of dissonance which undermine coherence and prevent NRE from being fully established. Dissonance arises primarily from four sources: i) NICE's specification of the principle of cost-effectiveness; ii) its approach to prioritising the needs of particular groups; iii) its conception of reasonableness in the context of uncertainty, and iv) its concern for innovation as an independent value. CONCLUSION At the time of analysis, the level of coherence across NICE policy provides reason to question the extent to which its formal approach to technology appraisal is morally justified. Some thoughts are offered on why, given these findings, NICE has been able to maintain its legitimacy as a healthcare priority-setter and on what could be done to enhance coherence.
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Affiliation(s)
- Victoria Charlton
- Department of Global Health and Social Medicine, King's College London, London, UK.
| | - Michael DiStefano
- Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus, Aurora, USA
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Young PD, Papanikitas AN, Spicer J. Medical ethics education as translational bioethics. Bioethics 2024; 38:262-269. [PMID: 38179595 DOI: 10.1111/bioe.13257] [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: 09/07/2022] [Revised: 08/27/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024]
Abstract
We suggest that in the particular context of medical education, ethics can be considered in a similar way to other kinds of knowledge that are categorised and shaped by academics in the context of wider society. Moreover, the study of medical ethics education is translational in a manner loosely analogous to the study of medical education as adjunct to translational medicine. Some have suggested there is merit in the idea that much as translational research attempts to connect the laboratory scientist's work to its implications for patient care, translational ethics focuses on bringing ethics scholarship into the sphere of personal and public action. We distinguish the term 'translational ethics' (the study of ethics being translated between academy, classroom and clinic) from other prominent definitions in the bioethics literature. To do this, we build off a notion of knowledge translation that focuses on the nonlinear movement of information that comes to professionals through multiple competing sources. We suggest that this knowledge, and particularly knowledge about ethics, becomes embodied by the individual. It is through a reflective practice that internally embedded ethics knowledge might be modified, and this work might be best carried out with a moral community that maintains a sense of practical wisdom. Applying this translational approach to the study of medical ethics education can be both academically relevant and practically useful. This view of translation can help bridge the evident, multidirectional relationships between research, education and performance. It might also create further opportunities to develop medical ethics education theory.
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Affiliation(s)
- Peter D Young
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew N Papanikitas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John Spicer
- Institute of Medical and Biomedical Education, St Georges University of London, Cranmer Terrace, London, UK
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Zwart H. The bioethics of synthetic cells. Nat Rev Mol Cell Biol 2024; 25:157-158. [PMID: 38081974 DOI: 10.1038/s41580-023-00693-w] [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: 02/28/2024]
Affiliation(s)
- Hub Zwart
- Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Kuehlmeyer K, Jansky B, Mertz M, Marckmann G. Transformative medical ethics: A framework for changing practice according to normative-ethical requirements. Bioethics 2024; 38:241-251. [PMID: 37366555 DOI: 10.1111/bioe.13185] [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: 09/11/2022] [Revised: 04/05/2023] [Accepted: 04/25/2023] [Indexed: 06/28/2023]
Abstract
We propose a step-by-step methodological framework of translational bioethics that aims at changing medical practice according to normative-ethical requirements, which we will thus call "transformative medical ethics." The framework becomes especially important when there is a gap between widely acknowledged, ethically justified normative claims and their realization in the practice of biomedicine and technology (ought-is gap). Building on prior work on translational bioethics, the framework maps a process with six different phases and 12 distinct translational steps. The steps involve various research activities including conceptual philosophical inquiry and (socio-)empirical research. On the one hand, the framework can be used as a heuristic tool to identify barriers to the transformation process. On the other hand, it can provide guidance for researchers and practitioners to develop appropriate (conceptual action and practice) models, which are then implemented and evaluated in specific practice contexts. We use the example of realizing the norm of respect for autonomy in the practice of medical decision-making to illustrate the framework. Further research is required, for example, to theoretically underpin the framework, to apply it to other ought-is gaps, and to evaluate its feasibility and effectiveness in various practice areas. Overall, the framework of transformative medical ethics suggests a strategic process to investigate and promote practice change that is ethically informed in all phases.
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Affiliation(s)
- Katja Kuehlmeyer
- Institute of Ethics, History and Theory of Medicine, Medical Faculty, LMU Munich, Muenchen, Germany
| | - Bianca Jansky
- Institute of Ethics and History of Health in Society, Medical Faculty, University of Augsburg, Augsburg, Germany
- Institute for Sociology, LMU Munich, Muenchen, Germany
| | - Marcel Mertz
- Hannover Medical School, Institute for Ethics, History and Philosophy of Medicine, Hannover, Germany
| | - Georg Marckmann
- Institute of Ethics, History and Theory of Medicine, Medical Faculty, LMU Munich, Muenchen, Germany
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Ray K, Cooper JF. The Bioethics of Environmental Injustice: Ethical, Legal, and Clinical Implications of Unhealthy Environments. Am J Bioeth 2024; 24:9-17. [PMID: 37104666 DOI: 10.1080/15265161.2023.2201192] [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: 06/19/2023]
Abstract
Environmental health remains a niche topic in bioethics, despite being a prominent social determinant of health. In this paper we argue that if bioethicists are to take the project of health justice as a serious one, then we have to address environmental injustices and the threats they pose to our bioethics principles, health equity, and clinical care. To do this, we lay out three arguments supporting prioritizing environmental health in bioethics based on bioethics principles including a commitment to vulnerable populations and justice. We also highlight and advocate for environmental law efforts that align with these priorities, focusing specifically on the need for a right to a healthy environment. Our intention is to draw attention to the legal and ethical concepts that underlie the importance of a healthy environment, and urge bioethicists to prioritize both legal and ethical advocacy against environmental injustices in their practice.
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Affiliation(s)
- Keisha Ray
- University of Texas Health Science Center at Houston
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Berger M. Additional Steps for Maintaining Public Trust in the FDA. Hastings Cent Rep 2024; 54:44. [PMID: 38639165 DOI: 10.1002/hast.1578] [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: 04/20/2024]
Abstract
This letter responds to the essay "Securing the Trustworthiness of the FDA to Build Public Trust in Vaccines," by Leah Z. Rand, Daniel P. Carpenter, Aaron S. Kesselheim, Anushka Bhaskar, Jonathan J. Darrow, and William B. Feldman, in the special report "Time to Rebuild: Essays on Trust in Health Care and Science," in the September-October 2023 issue of the Hastings Center Report.
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Dunn M, Sheehan M. The myth of translational bioethics. Bioethics 2024; 38:196-203. [PMID: 38058261 DOI: 10.1111/bioe.13245] [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: 09/21/2022] [Revised: 08/15/2023] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
In recent years, the case has been made for special attention to be paid to a branch of research in the field of bioethics called 'translational bioethics'. In this paper, we start by considering some of the assumptions that those advancing translational approaches to bioethics make about bioethics and compare them to the reality of bioethics as an academic field. We move on to explain how those who make this case, implicitly or explicitly, for translational bioethics go awry because of how they understand the 'gap' between bioethical inquiry and practical settings that requires bridging. We consider three interpretations of this 'translation gap' in bioethics: (i) the gap between theory and practice, (ii) the gap between the force of normative claims and practical contextual realities and (iii) the gap between relevance or applicability to practice and actual application or implementation in practice. In each case, we show how a proper understanding of the nature of the academic field of bioethics undermines how these gaps have been formulated, and how any need for talk of 'translational bioethics' is removed.
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Affiliation(s)
- Michael Dunn
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Sheehan
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Kadja K, Rodríguez-Arias D. Global Environmental Justice and Bioethics: Overcoming Beneficence and Individual Responsibility. Am J Bioeth 2024; 24:55-57. [PMID: 38393998 DOI: 10.1080/15265161.2024.2303143] [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: 02/25/2024]
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Pacia DM. Implementing Environmental Considerations into HRSA's Medically Underserved Area Designation. Am J Bioeth 2024; 24:38-40. [PMID: 38394021 DOI: 10.1080/15265161.2024.2303157] [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: 02/25/2024]
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Metselaar S. Translational bioethics as a two-way street. Developing clinical ethics support instruments with and for healthcare practitioners. Bioethics 2024; 38:233-240. [PMID: 37776570 DOI: 10.1111/bioe.13225] [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: 08/31/2022] [Revised: 07/11/2023] [Accepted: 09/01/2023] [Indexed: 10/02/2023]
Abstract
This article discusses an approach to translational bioethics (TB) that is concerned with the adaptation-or 'translation'-of concepts, theories and methods from bioethics to practical contexts, in order to support 'non-bioethicists', such as researchers and healthcare practitioners, in dealing with their ethical issues themselves. Specifically, it goes into the participatory development of clinical ethics support (CES) instruments that respond to the needs and wishes of healthcare practitioners and that are tailored to the specific care contexts in which they are to be used. The theoretical underpinnings of this participatory approach to TB are found in hermeneutic ethics and pragmatism. As an example, the development of CURA, a low-threshold CES instrument for healthcare professionals in palliative care, is discussed. From this example, it becomes clear that TB is a two-way street. Practice may be improved by means of CES that is effectively tailored to specific end users and care contexts. The other way around, ethical theory may be enriched by means of the insights gained from engaging with practice in developing CES in a process of co-creation. TB is also a two-way street in the sense that it requires collaboration and commitment of both bioethicists and practitioners, who engage in a process of mutual learning. However, substantial challenges remain. For instance, is there a limit to the extent to which a method of moral reasoning can be adapted in order to meet the constraints of a given healthcare setting? Who is to decide, the bioethicist or the practitioners?
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Affiliation(s)
- Suzanne Metselaar
- Ethics, Law, & Humanities, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
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Story A, Bell N, Schott S, Fletcher F, Kerr J. The Ethical Implications of Environmental Racism: Considerations for Advancing Health Equity. Am J Bioeth 2024; 24:35-37. [PMID: 38394020 DOI: 10.1080/15265161.2024.2303112] [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: 02/25/2024]
Affiliation(s)
- Alice Story
- Center for Medical Ethics and Health Policy, Baylor College of Medicine
| | | | - Sophie Schott
- Center for Medical Ethics and Health Policy, Baylor College of Medicine
| | - Faith Fletcher
- Health Promotion and Behavioral Sciences, University of Louisville
| | - Jelani Kerr
- Health Promotion and Behavioral Sciences, University of Louisville
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Lee LM. For Bioethics to Center Justice, We Must Reconsider Funding, Training, and the Taxonomy of Bioethics. Am J Bioeth 2024; 24:26-28. [PMID: 38394001 DOI: 10.1080/15265161.2024.2303145] [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: 02/25/2024]
Affiliation(s)
- Lisa M Lee
- Virginia Polytechnic Institute and State University
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Scarffe E, Polk A. What Do Rights Have to Do with It? Am J Bioeth 2024; 24:31-33. [PMID: 38394018 DOI: 10.1080/15265161.2024.2303111] [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: 02/25/2024]
Affiliation(s)
| | - Amber Polk
- Florida International University, College of Law
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