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Physicians generally recommend that patients resuscitated with naloxone after opioid overdose stay in the emergency department for a period of observation in order to prevent harm from delayed sequelae of opioid toxicity. Patients frequently refuse this period of observation despiteenefit to risk. Healthcare providers are thus confronted with the challenge of how best to protect the patient's interests while also respecting autonomy, including assessing whether the patient is making an autonomous choice to refuse care. Previous studies have shown that physicians have widely divergent approaches to navigating these conflicts. This paper reviews what is known about the effects of opioid use disorder on decision-making, and argues that some subset of these refusals are non-autonomous choices, even when patients appear to have decision making capacity. This conclusion has several implications for how physicians assess and respond to patients refusing medical recommendations after naloxone resuscitation. [ABSTRACT FROM AUTHOR]

Eating disorders are mental illnesses that can have a significant and persistent physical impact, especially for those who are not treated early in their disease trajectory. Although many persons with eating disorders may make a full recovery, some may not; this is especially the case when it comes to persons with severe and enduring anorexia nervosa (SEAN), namely, those who have had anorexia for between 6 and 12 years or more. Given that persons with SEAN are less likely to make a full recovery, a different treatment philosophy might be ethically warranted. One potential yet scarcely considered way to treat persons with SEAN is that of a harm reduction approach. A harm reduction philosophy is deemed widely defensible in certain contexts (e.g. in the substance use and addictions domain), and in this paper we argue that it may be similarly ethically defensible for treating persons with SEAN in some circumstances. [ABSTRACT FROM AUTHOR]

The article presents the discussion on trauma-informed approach to formulating hospital system policies and demonstrating the approach through discharge planning policy. Topics include supporting the trauma-informed principles of collaboration, mutuality, empowerment, and voice; and hospital systems showing concern about rising numbers of patients and families resistant to proposed discharge plans.

We argue for the addition of trauma informed awareness, training, and skill in clinical ethics consultation by proposing a novel framework for Trauma Informed Ethics Consultation (TIEC). This approach expands on the American Society for Bioethics and Humanities (ASBH) framework for, and key insights from feminist approaches to, ethics consultation, and the literature on trauma informed care (TIC). TIEC keeps ethics consultation in line with the provision of TIC in other clinical settings. Most crucially, TIEC (like TIC) is systematically sensitive to culture, history, difference, power, social exclusion, oppression, and marginalization. By engaging a neonatal intensive care ethics consult example, we define our TIEC approach and illustrate its application. Through TIEC we argue it is the role of ethics consultants to not only hold open moral spaces, but to furnish them in morally habitable ways for all stakeholders involved in the ethics consultation process, including patients, surrogates, and practitioners. [ABSTRACT FROM AUTHOR]

The development of artificial intelligence (AI) in medicine raises fundamental ethical issues. As one example, AI systems in the field of mental health successfully detect signs of mental disorders, such as depression, by using data from social media. These AI depression detectors (AIDDs) identify users who are at risk of depression prior to any contact with the healthcare system. The article focuses on the ethical implications of AIDDs regarding affected users' health-related autonomy. Firstly, it presents the (ethical) discussion of AI in medicine and, specifically, in mental health. Secondly, two models of AIDDs using social media data and different usage scenarios are introduced. Thirdly, the concept of patient autonomy, according to Beauchamp and Childress, is critically discussed. Since this concept does not encompass the specific challenges linked with the digital context of AIDDs in social media sufficiently, the current analysis suggests, finally, an extended concept of health-related digital autonomy. [ABSTRACT FROM AUTHOR]

In this article, I argue that (1) transgender adolescents should have the legal right to access puberty-blocking treatment (PBT) without parental approval, and (2) the state has a role to play in publicizing information about gender dysphoria. Not only are transgender children harmed psychologically and physically via lack of access to PBT, but PBT is the established standard of care. Given that we generally think that parental authority should not go so far as to (1) severally and permanently harm a child and (2) prevent a child from access to standard physical care, then it follows that parental authority should not encompass denying gender-dysphoric children access to PBT. Moreover, transgender children without supportive parents cannot be helped without access to health care clinics and counseling to facilitate the transition. Hence there is an additional duty of the state to help facilitate sharing this information with vulnerable teens. [ABSTRACT FROM AUTHOR]

The article focuses on commentaries that addresses new approaches to bioethics praxis, compliance/adherence and terminology and used terms like surveillance technology and self-acting medical devices (SAMD). It refers to the potential for digital pills to provide the best chance of maintaining or improving individuals' health by enhancing abilities to take their medications as prescribed.

Bioethicists often draw sharp distinctions between hope and states like denial, self-deception, and unrealistic optimism. But what, exactly, is the difference between hope and its more suspect cousins? One common way of drawing the distinction focuses on accuracy of belief about the desired outcome: Hope, though perhaps sometimes misplaced, does not involve inaccuracy in the way that these other states do. Because inaccurate beliefs are thought to compromise informed decision making, bioethicists have considered these states to be ones where intervention is needed either to correct the person's mental state or to persuade the person to behave differently, or even to deny the person certain options (e.g., another round of chemotherapy). In this article, we argue that it is difficult to determine whether a patient is really in denial, self-deceived, or unrealistically optimistic. Moreover, even when we are confident that beliefs are unrealistic, they are not always as harmful as critics contend. As a result, we need to be more permissive in our approach to patients who we believe are unrealistically optimistic, in denial, or self-deceived-that is, unless patients significantly misunderstand their situation and thus make decisions that are clearly bad for them (especially in light of their own values and goals), we should not intervene by trying to change their mental states or persuade them to behave differently, or by paternalistically denying them certain options (e.g., a risky procedure). [ABSTRACT FROM AUTHOR]

The article focuses on the author's views on lacking robust empirical support that violates the moral principles of equity and respect for persons. It mentions strong empirical evidence lack of social support to transplant failure, could overcome these violations and also highlights psychosocial listing criteria, for instance, criteria like mental health problems or a history of substance abuse.

The article offers further reasons why unrealistic optimism in patients' decisions should be respected as maintained in the article by Blumenthal-Barby and Ubel in 2018. Topics discussed include unrealistic optimism's potential in supporting a person's motivation, and pursuit and possible achievement of personal goals, and its tolerance in the health domain, but not in other life domains. Also noted is the difficult ascertainment of the effect of patients' beliefs on their treatment outcomes.

The article comments on the article "The harm principle cannot replace the best interest standard: Problems with using the harm principle for medical decision making for children" by J.C. Bester. It mentions that frequency with which reasonableness occurs invites an immediate clarification about the nature of any harm consensus in bioethics. It cites cases to illustrate that indeterminacy has a potential effect of allowing a decision maker to flexibly draw on one or more guiding principles.

The article focuses on ethical implications involved in role of genetics and genomics in health care delivery in low- and middle-income countries (LMICs). Topics include consideration of mental health stigma as major barrier for mental health services access and treatment in LMICs; role played by genomic knowledge in reducing blames imposed by patients with schizophrenia over early episode of drug abuse; and ethical risk associated with incorporation of genomic knowledge in clinical settings.

The article focuses on the issue of testicular tissue cryopreservation for boys and sperm banking and on the article "Expanding Access to Testicular Tissue Cryopreservation: An Analysis by Analogy" by Tuua Ruutiainen, Steve Miller, Arthur Caplan and Jill P. Ginsberg. In the article the author offers her opinions on the benefits of testicular tissue cryopreservation and on several points which are raised in Ruutiainen et al.'s article.