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Background. Registrars in specialisation training programmes encounter numerous difficulties in completing the research component of the Master of Medicine degree. Poor patient record-keeping hinders the research process. Objectives. To investigate current types of medical patient record-keeping systems (electronic v. paper) in training health facilities, and the effect data accessibility has on specialist training and research. Methods. This was a mixed-methods study that included both descriptive and analytical components. Of 610 postgraduate students enrolled in the University of KwaZulu-Natal College of Health Sciences Master of Medicine programme, 168 completed a cross-sectional survey to collect data and 11 did follow-up interviews. The survey and interviews explored issues related to medical record-keeping in the participants' department or hospital, emphasising their experiences with data access while conducting research. The quantitative data were analysed using descriptive statistics, and the qualitative data were analysed thematically. Ethical approval was obtained from the institution's Biomedical Research Ethics Committee. Results. Of the 168 participants, 94 (56%) reported that problems with data access hindered their research, while 56 (33%) indicated that data access did not affect their research. Only 30 participants (18%) had no difficulty in obtaining data for their research, while the rest (n=138; 82%) experienced varying degrees of difficulty. A total of 110 participants (65%) indicated that paper-based record-keeping was mainly being used in their department or hospital, while electronic record-keeping was reported by the rest (n=58; 35%). Many (n=125; 74%) expressed the need to improve hospital data management practices, and 39 (23%) reported that plans were being implemented to improve these practices. Participants expressed frustration with regard to accessing data even in departments that used electronic systems, and they raised concerns regarding data security. Conclusion. The migration to electronic patient record-keeping has not yet been implemented in many hospitals, with poor patient record-keeping affecting training and research. [ABSTRACT FROM AUTHOR]

There have been ongoing debates as to how, or even whether, we should clinically classify gender diversity in children through clinical classification manuals. So‐called 'depathologizing' is argued as being vital to address the stigma that these children are somehow disordered or sick. Yet one argument in favour of continued clinical classification for transgender and gender non‐conforming children is that it better facilitates access to specialist psychological support. I argue that whilst continued clinical classification offers a seemingly pragmatic solution to ensuring access, it does in fact obscure our understanding of the individual needs of these children. In this paper I address fundamental issues that aim to better our understanding of need and thus why a child may benefit from specialist support. I do so by critiquing a paper I nearly wrote, which argued for the ongoing continued classification of gender incongruence in children. Ultimately, I argue that specialist psychological support and care should be driven by the needs of the individual child, as determined by the child and those involved with their care. By bettering our understanding as to why specialist psychological support may be beneficial for some, we move past the focus of such specialist support being provided because of the child's gender diversity. Methodologically the paper may be unusual, in comparison to traditional normative counter‐argumentative bioethical position papers, but by presenting an argument for depathologization of gender diversity of children in this way there is also an alternative insight into the methods of bioethics. [ABSTRACT FROM AUTHOR]

This discussion article examines narrative positioning related to pain management for people who use substances at the end of life. We explore how dominant narrative genres associated with biomedicine, such as 'restitution' and narratives common within the context of drug services such as 'recovery' can hinder effective pain management within this population. We argue that these discourses can marginalise the ethical self-identity of patients who use substances at the end of life. It can also trouble health and social care professionals in supporting patients and generating counter-narratives that challenge those often associated with substance use. Stigma is a common experience for this population with stereotyping as 'junkies' and associated with criminality. They are positioned as drug-seeking, and this requires more surveillance at the end of life when opioid therapy is potentially more available and authorised. This can make it challenging to generate 'companion' stories that are positive and maintain moral adequacy. Dominant biomedical narrative genres often prevent the recognition of the fractured stories that people using substances can often present with. This can lead to narrative silencing and to the under treatment of pain. The person's self-identity is invested in narratives of recovery, and opioid use symbolises their addicted past because for practitioners, this population is at clinical risk with the potential for drug seeking behaviours. Whilst not requiring formal ethical review this discussion paper was constructed in accordance with good scientific practice with the work of other researchers respected and cited appropriately. [ABSTRACT FROM AUTHOR]

Objectives: This document provides an English translation of the Israeli Joint Commission's national guidelines for triaging severely ill patients during the coronavirus disease 2019 (COVID-19) pandemic. Methods: Four subcommittees of medical, legal, ethical-social, and religious experts developed the general principles and practical medical criteria for triaging scarce life-saving resources. Results: The guidelines provide an overview of general principles as well as pragmatic medical criteria and a practical triage protocol to be followed should the healthcare system be overwhelmed due to COVID-19. Issues covered include triggers for activating the guidelines, guiding ethical, legal, and religious principles, equity in access, fair distribution, transparency, consistency, palliation, medical policy prioritization, problem-solving mechanisms, and public trust. Conclusions: The Israeli consensus document and pragmatic medical triage protocol offer a societal and medical roadmap for allocating scarce resources during the COVID-19 pandemic or other disasters. [ABSTRACT FROM AUTHOR]

Women in the Netherlands with non-western migration backgrounds experience domestic violence at the intersection of culture and gender, and visit their general practitioners (GPs) with health concerns related to the violence. Drawing on semi-structured interviews with GPs, this paper illuminates how GPs navigate the process of decision-making around intervention in domestic violence, with particular attention to the role of autonomy. Patient autonomy is a core principle in Dutch general practice. The term refers to the principle that GPs must respect that competent adults can make autonomous decisions about the care they do and do not want, and that GPs must respect patients' views, choices, and ways of life. The interview data shows great variation in how GPs respond in situations of domestic violence against women with non-western migration backgrounds. Deploying 'somatechnics of perception', this paper explores how GPs' perceptions of their patients' autonomy are both the agent and effect of a complex and embodied negotiation of gender, race, culture, ethnicity, medical ethics, and morality. In highlighting how these patients' autonomy is rendered (un)intelligible and (il)legible in contextually specific ways, this paper sheds light on how GPs in the Netherlands can better assist women with non-western migration backgrounds who experience domestic violence. [ABSTRACT FROM AUTHOR]

Collegiality is one of the fundamental values of the nursing profession. During the nursing history, collegiality has been described as part of a nurse's relationship with their peers and it influences the quality of care they provide and job satisfaction and commitment to their work. Despite earlier definitions, the concept of collegiality in nursing has remained unclear. The aim of this study was to clarify the concept of collegiality in the nursing profession, using Rodger's evolutionary concept analysis. We carried out electronic searches using the CINAHL, PubMed, Scopus, Web of Science, SocINDEX, PsycINFO and Eric databases and manual searches of the reference lists of the selected papers. The searches were limited to peer-reviewed papers published in English language from the inception of database to November 2022. This identified 25 papers. Based on our analysis, the attributes of the concept of collegiality were achieving mutual goals together with equality, reciprocity, trusted advocacy, powerful self-regulation and engaged belongingness. Antecedents of the concept included existing professional group, connection between professionals and professional self-esteem. The consequences were strengthening nurses' professional status, job satisfaction and their ability to provide the best possible patient care. We found that nurses' collegiality was a value-based concept, with a unique character based on professional connections. The concept brought together ethical and pragmatic strategies to achieve the best possible results for the nursing profession. Provided knowledge can be applied for further development of the concept and applying it in clinical research and practice. The concept of nurses' collegiality should also be studied in the future because both the profession and their working environment are constantly changing. [ABSTRACT FROM AUTHOR]

This paper aims to refute a common line of argument that it is immoral for physicians to engage in medical assistance in death (MAiD), i.e., the practices of euthanasia and physician-assisted suicide. The argument in question is based on the notion that participating in MAiD is contrary to the professional-role obligations of physicians, due to MAiD's putative inconsistency with the ends of medicine. The paper describes several major flaws from which that argument suffers. [ABSTRACT FROM AUTHOR]

This paper seeks to reimagine ethical leverage in technology for peaceful synodality (the term peaceful synodality is coined to mean a synodality that welcomes participation and inclusion of people from different backgrounds and views without compromising the truth and respecting their dignity and journeying together) through the lens of the bioethics of synodality with technology. The concept of this paper is that technology can be leveraged ethically to promote peaceful synodality in the Catholic Church and that such an approach to technology is rooted in reimagining a bioethics of synodality that emphasize the need for journeying hand in hand with the speed at which technological advancement moves in order to enhance ethical decision-making processes. Ethics has moved at a different pace than technology, especially in matters involving human life. Ethics has been viewed as problematic in technology, especially where science wants to be neutral, but rethinking ethics as a companion of emerging technologies will be helpful in directing the ethical uptake of technology. To argue this thesis, the paper will employ a review of relevant literature while presenting the theological and ethical perspectives of synodality. By and large, an interdisciplinary approach will be employed where various disciplines play a key role. Such methodology advances the theme of reimagining Catholic ethics by offering a fresh perspective on the ethical implications of technology in the context of synodality. By emphasizing the importance of journeying together through enhanced ethical guidelines for proper decision-making and by exploring how technology can respect human rights and dignity among other values, this paper contributes to a broader conversation about how Catholic ethics can be reimagined in light of technological developments. Ultimately, this paper argues that a bioethics of synodality with technology can offer a vision for technology that is grounded in Catholic social teaching that promotes universally accepted human dignity and the common good. A cross-cutting method will also be used, given that ethics has basically constant principles, yet technology keeps on changing. Reimagining ethics means studying the advancement brought about by biotechnology and seeing to what degree human beings are affected in their basic rights and the risks versus the benefits brought about by the same. The assumption is that decisions made regarding the ethics of various technologies will be at par with the rate at which new technologies emerge and are employed. What is of vital importance is that ethics can have the power to journey together with technology, not as an adversary but in synodality. Reimagining ethics means being ever alert in the developing technologies that serve humanity so that in consultation with various experts, the best practices can be embraced within the ethical guidelines for the common good. The outcome of this research is that reimagining Catholic ethics involves listening to the needs of humanity and how technology is bringing solutions to them. Participating in bioethical debates, training on bioethics and listening to experts in various fields will enable a critical, analytical and pneumatological discernment of how ethical decisions on frontier technologies can benefit non-humans and humans. [ABSTRACT FROM AUTHOR]

This paper discusses the lasting impact of the Covid-19 pandemic on research ethics in social sciences by focusing on the concept of vulnerability. We unpack the current conceptualisations of vulnerability and their limitations and argue for the need to reconceptualise vulnerability as multidimensional, consisting of both universal and contextual dimensions, as well as their dynamic interplay. Multidimensional vulnerability is inspired by and relevant to social science research during the pandemic but can also be useful in other contexts such as climate change or conflict. The paper puts forwards several considerations about how this revised concept of vulnerability may be useful when evaluating ethical dimensions of social science research. [ABSTRACT FROM AUTHOR]

Introduction: Public health ethics addresses moral dilemmas arising from balancing individual healthcare needs with societal interests. Ethical considerations in public health during pandemics and disasters aim to reduce mortality rates and minimize social injustice through fair principles. Objective: This paper analyzes public health ethics and ethical values in allocating resources during mass casualty incidents. The intersection of public health ethics, applied bioethics, and ethics of social consequences (through non-utilitarian consequentialism) guides addressing serious public health challenges in catastrophic scenarios. The application of the given interaction is significant for professional medical ethics. Methodology: The paper employs inductive, deductive, and normative methods of bioethics and the methodology of ethics of social consequences. Conclusion: The paradigmatic disparity between the bioethics of pandemics and disaster bioethics lies in the fluid application of bioethical principles and the accentuation of utilitarian demands depending on the severity and scale of mass casualty incidents. Applied bioethics in crisis situations respects the approaches of public health ethics and attempts to increase positive social outcomes. The application of (scarce) resource allocation criteria and triage of patients is derived from ethical decisions beneficial to public health and lege artis approaches of medical bioethics. The paper presents professional and ethical criteria for medically inappropriate treatment within the framework of patient triage; we approach crisis ethics from the perspective of maximization of benefit. Age is not an exclusion criterion of acute healthcare provision in crisis situations. Ethics of social consequences as a form of non-utilitarian consequentialism allowing for social consequences bridges public health ethics and applied bioethics. [ABSTRACT FROM AUTHOR]

The action required to stem the environmental and social implications of climate change depends crucially on how humankind shapes technology, economy, lifestyle and policy. With transport CO2 emissions accounting for about a quarter of the total, we examine the contribution of CO2 output by scientific travel. Thankfully for the reputation of the scientific community, CO2 emissions associated with the trips required to present a paper at a scientific conference account for just 0.003% of the yearly total. However, with CO2 emissions for a single conference trip amounting to 7% of an average individual’s total CO2 emissions, scientists should lead by example by demonstrating leadership in addressing the issue. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The text discusses the structural constraints that affect decisions about participation in genomic and precision medicine. It highlights disparities and delays in access to genetic services for patients with low incomes and underserved racial and ethnic groups. These disparities can be attributed to inadequate preparation for genomic medicine at the health system and provider levels. The text also mentions barriers at the patient level, such as high out-of-pocket costs and lack of coverage for clinical genetic testing. The importance of empirical research in understanding and resolving these barriers is emphasized, particularly in underrepresented populations. The text includes four primary research papers that explore the influence of context and diverse lived experiences on decisions about participation in genomic and precision medicine. These papers highlight the need for further study and collaboration within the ELSI research community. [Extracted from the article]

This paper was written in the framework of my internship at the National Commission for Bioethics and Technoethics of the Hellenic Republic. It constitutes an attempt at exploring the ethical and legal dilemmas of the medical practice of telepsychiatry. Telepsychiatry, as well as other forms of telemedicine, has become a prevalent way through which patients gain access to healthcare and with many research papers reporting on its effectiveness and advantages, telepsychiatry has gained a lot of proponents in the scientific and healthcare community. However, several questions regarding the ethical and legal nature of the practice remain unanswered and this can put patients and other users of telemental health services under risk for basic rights violations. In this paper, at first the scientific data supporting the use of telepsychiatry will be cited. In addition to that, there will be discussion of several ethical dilemmas that have been reported concerning the use of telemedicine in psychiatry during the past few years and there will be reference to the medical code of ethics. Following that, there will be reference to the existing legislation for telepsychiatry in Greece and the legal issues that can arise will be analyzed. In spite of the fact that the advantages and ethical pitfalls of telepsychiatry are common in many countries, the focus of this paper will be on Greece’s code of medical ethics and legislation due to the lack of relevant bibliography on the matter, even though telepsychiatry is widely used by Greek patients. Finally some suggestions will be made on what ought to be ameliorated in regards to the current conditions, so as to make sure telepsychiatry is in line with the basic principles of bioethics. [ABSTRACT FROM AUTHOR]

This paper will take as its starting point the premise that developing translational bioethics is a worthwhile endeavour. I will develop an account of translational bioethics and discuss what implications this would have for the wider discipline of bioethics and argue that this would be a useful development for bioethics. The paper will conduct a form of 'translational meta‐bioethics analysis', in the words of Bærøe. I will argue that if we are serious about instituting translational bioethics, then it will need to look and be organised in a very different way from current bioethics research, this will be a radically different form of bioethics from what we currently have. In this paper I will sketch what translational bioethics might look like. My proposal here is not that translational bioethics should supplant existing ways of doing bioethics, but rather that it should be an addition to it, another subdiscipline of bioethics. [ABSTRACT FROM AUTHOR]

Children with innate variations of sex characteristics (also termed differences of sex development or intersex traits) are routinely subjected to medical interventions that aim to make their bodies appear or function more typically female or male. Many such interventions lack clear evidence of benefit, they have been challenged for thirty years, and they are now understood to violate children's rights to bodily autonomy and bodily integrity. In this paper I argue that these persist in part due to epistemic injustices and biomedical authority. Epistemic injustices include limited disclosure of current practices, the systemic marginalisation of community voices and psychosocial professionals, and attempts to discredit or misrepresent testimony. Bioethics has largely failed to change medical practice, and sometimes plays a role in perpetuating epistemic injustices. I find that the development of an intersex movement provides opportunities for epistemic justice and liberation by engaging with other disciplines and promoting oversight of medical decision-making. The paper draws particularly on Australian sources, including internationally influential ethical principles. [ABSTRACT FROM AUTHOR]

The essay outlines a four-phase triage process made by a fictive Talmudic rabbi working on an equally fictive hospital COVID-19 ward. The rabbi bases his decision on four different Talmudic texts, proceeding one by one, with each text building on the preceding one, until he is ready to allocate his scarce medical resources to one of the patients, thus being forced to deny them to others. Along the way, the paper will examine how this Talmudic reasoning can also be applied to the patient, or even a potential patient, clarifying the demands of the individual's ethical responsibility to avoid triage situations in the first place through social distancing and even more so through getting vaccinated. The paper argues that the rabbi has a number of Talmudic tools at hand that make his decision easier, not because he strictly follows Jewish law, but because of the rich experience standing behind Jewish legal traditions, making a universally valid ethical justification of difficult decisions possible. The essay proposes that including such theological material in triage guidelines would help make those decisions more acceptable in the long run, especially for societies in which religious traditions still play a certain role in the cultural consciousness. [ABSTRACT FROM AUTHOR]

This paper addresses normative issues that arise in relation to indicators and measures of health impact. With inspiration from Nicole Hassoun's recent proposal, the paper argues and illustrates that those interested in measuring global health impact face questions about how to prioritize among those with ill‐health, how to weigh benefits to those who cannot lead minimally good lives against benefits to the better off, and how to think about whether someone is badly off. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Implantable Cardioverter Defibrillator (ICD) implantation has significantly modified the natural history of patients at high risk of sudden cardiac death (SCD) in various types of heart diseases. However there is a high rate of psychological distress and reduced quality of life in patients with an ICD, more evident in younger individuals. The ICD removal upon patient request is a very rare event and causes many clinical and ethical issues.The article discusses the case of a young patient affected by hypertrophic obstructive cardiomyopathy, who underwent implantable cardioverter defibrillator (ICD) implantation as a primary prevention of sudden cardiac death (SCD). Two years after the implantation, the patient repeatedly requested removal of the ICD due to of a significant and untreatable psychological device intolerance.Intervention became possible only after extensive psychological evaluation, which excluded specific pathology, and the ratification of Italian law 219/2017 on informed consent and advance directives, which guarantees the patient's independent decisions on current and future medical treatment. The explantation was performed 7 years after the implant. The patient is alive and in good health.The paper debates the issues related to establishing a patient–physician relationship based on respect for the patient's autonomy and experience of illness, in reference to principles such as beneficence and non‐maleficence, and the conflicts that sometimes arise between them.If a paternalistic approach in the patient–physician relationship evolves into a patient‐centered model, it is more certain that the patient's choice is realistically known and shared, and that it is consistent with the patient's values and life goals.The shared decision making (SDM) process and the use of pathology‐specific decision aids are able to transform the informed consent tool, usually related to medical‐legal issues, into an aid for true partnership between the patient and the medical care team. [ABSTRACT FROM AUTHOR]

AbstractThis paper argues that bioethics as a field should broaden its scope to include the ethics of war, focusing on war’s public health effects. The “Introduction” section describes the bioethics literature on war, which emphasizes clinical and research topics while omitting public health. The section, “War as a public health crisis” demonstrates the need for a public health ethics approach by framing war as a public health crisis. The section, “Bioethics principles for war and public health” proposes six bioethics principles for war that address its public health dimensions: health justice, accountability, dignified lives, public health sustainability, nonmaleficence, and public health maximization. The section, “Justifying and applying bioethical principles” shows how these principles inform ethical analysis, including just war theory and military ethics. The section, “From principles to practice” envisions ways in which bioethicists can promote these principles in practice through research, teaching, and service. The “Conclusion” section urges bioethicists to engage with war as a public health crisis, including calling attention to war’s impact on civilians, especially women, children, and other vulnerable groups. [ABSTRACT FROM AUTHOR]

The objective of this paper is to determine to what extent clinical research meets moral criteria. We will briefly present virtue ethics, duty ethics, utilitarian ethics, human rights theory, and end we will end with a few words about moral bioimprovement. [ABSTRACT FROM AUTHOR]

Over the last three quarters of a century, international guidelines and regulations have undergone significant changes in how children are problematised as participants in biomedical research. While early guidelines enacted children as vulnerable subjects with diminished autonomy and in need of special protection, beginning in the early 2000s, international regulatory frameworks defined the paediatric population as vulnerable due to unaddressed public health needs. More recently, ethical recommendations have promoted the active engagement of minors as research partners. In this paper, I adopt a post-structuralist approach to policy analysis to examine deep-seated assumptions and presuppositions underlying the changes in the problematisation of children as biomedical research participants over time. While biomedical research ethics focuses on the autonomy and vulnerability of minors, ethical guidelines are situated in specific sociocultural contexts, shaped, among other things, by contingent public health needs and changing conceptions of the value of research and science for society. In the process, I demonstrate the challenge of moving away from an approach that in taking adults as the model overshadows the complexity of children's lived experiences as well as their personal, cultural, and social lives. The lack of acknowledgement of this complexity makes children vulnerable to epistemic injustice, which is particularly crucial to address in public involvement initiatives. [ABSTRACT FROM AUTHOR]

Noninvasive prenatal testing (NIPT) has become widely available in recent years. While initially used to screen for trisomies 21, 18, and 13, the test has expanded to include a range of other conditions and will likely expand further. This paper addresses the ethical issues that arise from one particularly controversial potential use of NIPT: screening for adult‐onset conditions (AOCs). We report data from our quantitative survey of Australian NIPT users' views on the ethical issues raised by NIPT for AOCs. The survey ascertained support for NIPT for several traits and conditions including AOCs. Participants were then asked about their level of concern around implications of screening for AOCs for the future child and parent(s). Descriptive and comparative data analyses were conducted. In total, 109 respondents were included in data analysis. The majority of respondents expressed support for NIPT screening for preventable (70.9%) and nonpreventable AOCs (80.8%). Most respondents indicated concern around potential harmful impacts associated with NIPT for AOCs, including the psychological impact on the future child and on the parent(s). Despite this, the majority of participants thought that continuation of a pregnancy known to be predisposed to an AOC is ethically acceptable. The implications of these data are critically discussed and used to inform the normative claim that prospective parents should be given access to NIPT for AOCs. The study contributes to a body of research debating the ethical acceptability and regulation of various applications of NIPT as screening panels expand. [ABSTRACT FROM AUTHOR]

Mobile Health (m‐health) technologies, such as wearables, apps, and smartwatches, are increasingly viewed as tools for improving health and well‐being. In particular, such technologies are conceptualized as means for laypersons to master their own health, by becoming "engaged" and "empowered" "managers" of their bodies and minds. One notion that is especially prevalent in the discussions around m‐health technology is that of empowerment. In this paper, I analyze the notion of empowerment at play in the m‐health arena, identifying five elements that are required for empowerment. These are (1) knowledge, (2) control, (3) responsibility, (4) the availability of good choices, and (5) healthy desires. I argue that at least sometimes, these features are not present in the use of these technologies. I then argue that instead of empowerment, it is plausible that m‐health technology merely facilitates a feeling of empowerment. I suggest this may be problematic, as it risks placing the burden of health and behavior change solely on the shoulders of individuals who may not be in a position to affect such change. [ABSTRACT FROM AUTHOR]

The integration of normative analysis with empirical data often remains unclear despite the availability of many empirical bioethics methodologies. This paper sought bioethics scholars' experiences and reflections of doing empirical bioethics research to feed these practical insights into the debate on methods. We interviewed twenty-six participants who revealed their process of integrating the normative and the empirical. From the analysis of the data, we first used the themes to identify the methodological content. That is, we show participants' use of familiar methods explained as "back-and-forth" methods (reflective equilibrium), followed by dialogical methods where collaboration was seen as a better way of doing integration. Thereafter, we highlight methods that were deemed as inherent integration approaches, where the normative and the empirical were intertwined from the start of the research project. Second, we used the themes to express not only how we interpreted what was said but also how things were said. In this, we describe an air of uncertainty and overall vagueness that surrounded the above methods. We conclude that the indeterminacy of integration methods is a double-edged sword. It allows for flexibility but also risks obscuring a lack of understanding of the theoretical-methodological underpinnings of empirical bioethics research methods. [ABSTRACT FROM AUTHOR]

The right to health is linked to life and human dignity. Among the instruments to make it effective, the phenomenon of health litigation has become prominent. In Brazil, courts are increasingly faced with the task of rendering verdicts concerning matters related to health. Nowadays, judges have to deal with issues about health policies, technology incorporations, drug supplies, human autonomy, genetics, and biotechnologies, among others. Lawsuit sentences are now to be built upon the resolution of ethical, legal and philosophical questions. Bioethics presents itself as an instrument and method to help solve legal cases involving the right to health. This paper intends to show that bioethics can be applied in verdicts of lawsuits regarding to right to health in Brazil. It highlights that bioethics can be considered a source of law due to its normative dimension, as well as a hermeneutic method. This essay also aims to show the role for bioethics to help interpret the law and solve hard cases within health law and the right to health. Lastly, it aims to justify the presence of bioethics as legal reasoning to be used by judges in the foundation of their verdicts in lawsuits involving the right to health. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Simple Summary: Some basic and preclinical biomedical research models require the use of animals. It is not always clear which model is best suited to a project—animals or models based on, e.g., in vitro or in silico methods? This choice is influenced not only by personal beliefs and experience, but also by societal debates. Moreover, people often process information unconsciously. In this study, 13 people involved in relevant areas of research were interviewed. The responses were qualitatively assessed and subjected to an ethical analysis. This paper presents 66 reasons why researchers use animals (27 reasons) or alternative methods (39). Many reasons are tied to the work environment (29) and to scientific standards (22). Such reasons are often pragmatic and can only be influenced by individuals to a limited extent. Other reasons were assigned to personal attitudes (11) and animal welfare (4). Even if few reasons can be rejected outright from an ethical point of view, there are good reasons to give some more weight than others, as an exemplary discussion shows. The study raises awareness of the ethical decision-making process and the underlying reasons that we are often unaware of. This can help to reflect on and justify decisions. Background: Research model selection decisions in basic and preclinical biomedical research have not yet been the subject of an ethical investigation. Therefore, this paper aims, (1) to identify a spectrum of reasons for choosing between animal and alternative research models (e.g., based on in vitro or in silico models) and (2) provides an ethical analysis of the selected reasons. Methods: In total, 13 researchers were interviewed; the interviews were analyzed qualitatively. The ethical analysis was based on the principlism approach and a value judgement model. Results: This paper presents 66 reasons underlying the choice of researchers using animal (27 reasons) or alternative models (39). Most of the reasons were assigned to the work environment (29) and scientific standards (22). Other reasons were assigned to personal attitudes (11) and animal welfare (4). Qualitative relevant normative differences are presented in the ethical analysis. Even if few reasons can be rejected outright from an ethical point of view, there are good reasons to give some more weight than others. Conclusions: The spectrum of reasons and their ethical assessment provide a framework for reflection for researchers who may have to choose between animal models and (investing in) alternatives. This can help to reflect on and ethically justify decisions. [ABSTRACT FROM AUTHOR]

This paper provides a general framework for conceptualizing triage for intensive care unit admissions in public health emergencies such as the COVID‐19 pandemic. It applies this framework to some of the guidelines issued during the pandemic and addresses some controversial issues, including the role of age, the use of lives or life years, and the relevance of quality of life considerations. The paper defends a view on which triage protocols for public health emergencies should aim to maximize the number of life years saved, may take into account age as a proxy, and should ignore quality of life considerations. [ABSTRACT FROM AUTHOR]

Living labs are interdisciplinary and participatory initiatives aimed at bringing research closer to practice by involving stakeholders in all stages of research. Living labs align with the principles of participatory research methods as well as recent insights about how participatory ways of generating knowledge help to change practices in concrete settings with respect to specific problems. The participatory, open, and discussion‐oriented nature of living labs could be ideally suited to accompany ethical reflection and changes ensuing from reflection. To our knowledge, living labs have not been explicitly trialed and reported in ethics literature. In this discussion paper, we report and discuss four initial issues that marked the process of setting up a living lab in ethics: (1) determining the goals and expected outcomes of an ethics living lab; (2) establishing operational procedures; (3) selecting communities and defining pilot projects; and (4) adopting a lens to tackle emerging questions and challenges. We explain these four issues and present the paths taken based on the novel and specific orientation, that is, living ethics, at the basis of this project. In alignment with living ethics and É‐LABO, we approach challenges as learning opportunities to ask not only "how" questions but also "why" questions. We hope that this discussion paper informed by our experience helps to clarify the theoretical, methodological, and practical approaches necessary to successfully adopt and employ living labs in ethics. [ABSTRACT FROM AUTHOR]

This paper addresses bioethics in the context of the coronavirus disease 2019 (COVID‐19) pandemic. The Introduction (Section 1) highlights that at the field's inception, infectiousness was not front and center. Instead, infectious disease was widely perceived as having been conquered. This made it possible for bioethicists to center values such as individual autonomy, informed consent, and a statist conception of justice. Section 2 urges shifting to values more fitting for the moment the world is in. To find these, it directs attention to the Global South, and in particular, Africa, and to the values of ubuntu, solidarity, dignity, kinship, and humility. The paper concludes (in Section 3) that 21st‐century challenges facing bioethics are increasingly global, and calls on bioethicists themselves to be more globally inclusive in their approaches. [ABSTRACT FROM AUTHOR]

Artificially intelligent systems (AISs) are being created by software developing companies (SDCs) to influence clinical decision‐making. Historically, clinicians have led healthcare decision‐making, and the introduction of AISs makes SDCs novel actors in the clinical decision‐making space. Although these AISs are intended to influence a clinician's decision‐making, SDCs have been clear that clinicians are in fact the final decision‐makers in clinical care, and that AISs can only inform their decisions. As such, the default position is that clinicians should hold responsibility for the outcomes of the use of AISs. This is not the case when an AIS has influenced a clinician's judgement and their subsequent decision. In this paper, we argue that this is an imbalanced and unjust position, and that careful thought needs to go into how personal moral responsibility for the use of AISs in clinical decision‐making should be attributed. This paper employs and examines the difference between prospective and retrospective responsibility and considers foreseeability as key in determining how personal moral responsibility can be justly attributed. This leads us to the view that moral responsibility for the outcomes of using AISs in healthcare ought to be shared by the clinical users and SDCs. [ABSTRACT FROM AUTHOR]

Fear and anxiety can interfere profoundly with a person's ability to deliberate. Patients sometimes face critical medical decisions while subject to intense emotions which involve catastrophic (or wishful) convictions about the future. Medical teams, and even psychiatrists and bioethicists, lack a model for what to do in such cases. Philosophical accounts of autonomy and the clinical criteria for decision‐making capacity derived from them fail to address cases in which emotions do not merely skew judgment but rather block decision‐making capacity itself. This paper provides an account of when emotions undermine a person's freedom to deliberate, which is the basis of the capacity for autonomy. People subject to what I call 'concretized emotions' meet the cognitive criteria for decision‐making capacity. Yet their emotions dictate their views of reality and prevent them from meeting the basic conditions for deliberation. To deliberate one needs to be able to think through alternatives, and this thinking through alternatives needs to be responsive to evidence. With concretized fear, both the ability to think through alternatives and the ability to respond cognitively to evidence is undermined. The person can engage in apparent deliberation, but her thought processes regarding the feared matter are characterized by the rigid view that things are just as they seem from her emotional view. This paper develops a theoretical and clinical model for a more appropriate and nuanced approach to acting responsibly toward patients subject to intense fear and related emotional states that block their decision‐making capacity. [ABSTRACT FROM AUTHOR]

This paper examines the recent policy update by the College of Physicians and Surgeons of Ontario (CPSO), which allows physicians to override patient wishes for cardiopulmonary resuscitation (CPR) without consent. It critically analyzes the ethical implications of this shift, emphasizing the juxtaposition between the legal protections for patient’s Last Wills and the relatively diminished safeguarding of their end-of-life care preferences. The paper highlights the potential for bias in physician decision-making, the risk of reverting to a more paternalistic healthcare model, and the challenge of balancing patient autonomy with medical authority. The study underscores the need for a nuanced approach to healthcare policy that respects patient autonomy while addressing the complexities of end-of-life decisions. [ABSTRACT FROM AUTHOR]

The issues presented in this paper underscore conclusions in that this area is one that begs for research into alternative methods of assessment, care giving, and treatment planning. It is one that requires caregivers to be educated in the attendant dangers of restraints use and alternatives to their use. Alternatives that can be considered include: time out, constant observations, counseling (verbal interaction), de-escalation, medication, offering positive reinforcement for improved behavior, food and drinks, decreased stimulation, punch bags, exercise and relaxation techniques. And recently, the clinical application of interventions grounded in behavioral science and technology, which seem promising in reducing aggressive behavior, thus reducing the use of restraints. [ABSTRACT FROM AUTHOR]

The Fraser Health Authority (FHA) has established a framework of commitments to guide a range of issues from incorporating diversity, equity, and inclusion in clinical and policy decisions and responding to the historical and continuing discrimination against First Nations, Métis, and Inuit peoples, to creating psychologically safe environments, and dealing with harassment, bullying and other disrespectful behaviours. FHA Ethics Services hosted a workshop as part of the 2023 Canadian Bioethics Society-Société canadienne de bioéthique (CBSSCB) Workshop and Community Forum to create an opportunity for critical reflection and discuss strategic responses for the organization to live up to these commitments. This paper summarizes the workshop and identifies key insights and issues that emerged as areas that should be addressed in responding to diversity and inequality in the health system. [ABSTRACT FROM AUTHOR]

This paper summarizes the presentation and stakeholder feedback gathered from the Canadian Bioethics Society Workshop and Community Forum in May 2023, in a session entitled, “Clinical Ethics Fellowship in Canada: Making the Move Towards Standardization”. This summary provides insight into the clinical ethics fellowship landscape across Canada, including current gaps in the training of Canadian healthcare ethicists and opportunities to advance the journey towards standardization. [ABSTRACT FROM AUTHOR]

Globally exacerbated surgical waitlists have provided the opportunity to reflect on prioritization and resource allocation decisions. The unique circumstances of paediatric surgery and consequences of surgical delay prompted the study reported in this paper. As part of a larger project to attend to prioritization in our surgical waitlists, we conducted a Quality Improvement study, the purpose of which is to understand surgeon's perspectives regarding the ethical and practical realities of surgical prioritization at our institution. The study comprises semi-structured interviews with nine full-time paediatric surgeons from a variety of subspecialties conducted at our institution, which is a tertiary paediatric hospital with ten surgical subspecialties in a publicly funded healthcare system. Participants articulated how they prioritize their waitlists, and how they understand ethical prioritization. These findings resonate with the growing public concern for ethical practice in healthcare delivery and transparency in prioritization and resource allocation practices. Specifically, more transparency, consistency, and support is required in prioritization practices. This work highlights the importance of institutional dialogue regarding surgical case prioritization. Because quality improvement work is necessarily site-specific, concrete generalizations cannot be offered. However, the insights gleaned from these interviews and the process by which they were gleaned are a valuable knowledge-sharing resource for any institution that is interested in ongoing quality improvement work. The objectives here were to clarify the goals of prioritization within the institution, improve prioritization practices, and make them more ethical and transparent. [ABSTRACT FROM AUTHOR]

Human challenge studies, in which human research subjects are intentionally exposed to pathogens to contribute to scientific knowledge, raise many ethical complexities. One controversial question is whether it is ethically permissible to include children as participants. Commentary of the past decades endorses the exclusion of children, while new guidance suggests that pediatric human challenge studies can be ethically permissible. This paper argues that neither children's exclusion nor their inclusion are well justified. I examine and reject three arguments for exclusion, but suggest that these arguments establish pediatric human challenge studies as a complex ethical category of research that requires caution. I then argue for a strong presumption against children's inclusion, by drawing on an analogy to children's inclusion in phase I trials, emphasizing a requirement of necessity, and suggesting that accommodating children's vulnerability promotes an age de‐escalation approach for pediatric human challenge studies research. In the final section, I suggest a procedure for ethics review. [ABSTRACT FROM AUTHOR]

Bioethics provides a new perspective for the comparative study of Christianity and Chinese Buddhism. This paper provides a comprehensive comparison of the sources, states of existence, and fundamental principles and purposes of the Christian and Chinese Buddhist perspectives on human life, focusing specifically on the realm of bioethics. It places special emphasis on teachings about God's creation and dependent origination, original sin and Buddhist causality, as well as love and compassion. Despite the significant geographic distance between Christianity and Chinese Buddhism, the dialogue highlights potential cultural differences and interpretations. It also demonstrates mutual acceptance and the process of redefining one's own identity. Religious bioethics greatly benefits from a comprehensive study of various religions from around the world. It aims to encourage cross-cultural and interdisciplinary research on different religions globally. It promotes religious bioethics as a relevant field of study. [ABSTRACT FROM AUTHOR]

Sudden cardiac death (SCD) is a global health problem that requires, in many cases, cardiopulmonary resuscitation (CPR) and automatic external defibrillation (AED). Generally, it is initiated by a witness and continued by trained personnel. Many of the patients who suffer from SCD have a history of cardiac problems, and the decision to start CPR bystander must be made in seconds, which entails medical and bioethical decisions. Some of these decisions involve not only the initial rescuer but also health personnel and the family, and everyone must be conscious that a patient's death is possible. The objective of this paper is to mention the main bioethical considerations that are directly related to CPR, both the people who receive it and those who administer it in the context of SCD. [ABSTRACT FROM AUTHOR]

In a recent issue of the Cambridge Quarterly of Healthcare Ethics, Emily Carroll and Parker Crutchfield published a paper entitled, "The Duty to Protect, Abortion, and Organ Donation." They argued that a prohibition on abortion is morally equivalent to a positive mandate for parents to donate organs to their children and that opponents of abortion must be prepared to accept these mandates to remain consistent. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The leading models of disability struggle to fully encompass all aspects of "disability." This difficulty arises, the author argues, because the models fundamentally misunderstand the nature of disability. Current theoretical approaches to disability can be understood as "nounal," in that they understand disability as a thing that is caused or embodied. In contrast, this paper presents an adverbial perspective on disability, which shows that disability is experienced as a personally irremediable impediment to daily-living tasks or goals-like-ours. The picture theory of disability technically constitutes a species of relational approach because its analysis references the interplay between an individual and their environment; it differs from other relational accounts, however, by interpreting disability as a certain kind of negative experience—rather than a function of that relationship. This purely descriptive theory makes no normative claims about disability and operates as both a mechanism for the evaluation of the experience of disability and a heuristic device for the proper interpretation of disability. When disability is reframed in this way, the theory offers a particularist perspective which shows if, when, where, and how disability is experienced. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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? [ABSTRACT FROM AUTHOR]

Translational ethics (TE) has been developed into a specific approach, which revolves around the argument that strategies for bridging the theory‐practice gap in bioethics must themselves be justified on ethical terms. This version of TE incorporates normative, empirical and foundational ethics research and continues to develop through application and in the face of new ethical challenges. Here, I explore the idea that the academic field of bioethics has not yet sufficiently analysed its own philosophical foundation for how it can, and should, be practically relevant; neither has it comprehensively discussed the limitations on what impacts bioethicists should pursue. As a result, there has not been adequate training on how to suitably and appropriately impact real‐world practices. Moreover, bioethical perspectives are often competing with other strong interests, for example, economic and political, which may weaken their impact on policy‐making. The TE approach I propose can not only facilitate practical impacts of academic bioethics by being better informed by real‐world ethical issues but it also supports targeted and ethical justifications of the actual impact of academic work in real‐world contexts. In this paper, I clarify the premises for this TE approach, identify further challenges and sketch out potential solutions for the implementation of this methodological framework. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The pandemic significantly raised the stakes for the translation of bioethics insights into policy. The novelty, range and sheer quantity of the ethical problems that needed to be addressed urgently within public policy were unprecedented and required high‐bandwidth two‐way transfer of insights between academic bioethics and policy. Countries such as the United Kingdom, which do not have a National Ethics Committee, faced particular challenges in how to facilitate this. This paper takes as a case study the brief career of the Ethics Advisory Board (EAB) for the NHS Covid‐19 App, which shows both the difficulty and the political complexity of policy‐relevant bioethics in a pandemic and how this was exacerbated by the transience and informality of the structures through which ethics advice was delivered. It analyses how and why, after EAB's demise, the Westminster government increasingly sought to either take its ethics advice in private or to evade ethical scrutiny of its policies altogether. In reflecting on EAB, and these later ethics advice contexts, the article provides a novel framework for analysing ethics advice within democracies, defining four idealised stances: the pure ethicist, the advocate, the ethics arbiter and the critical friend. [ABSTRACT FROM AUTHOR]