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The possibility of employing human enhancement interventions to aid in future space missions has been gaining attention lately. These possibilities have included one of the more controversial kinds of enhancements: biomedical moral enhancement. However, the discussion has thus far remained on a rather abstract level. In this paper we further this conversation by looking more closely at what type of interventions with what sort of effects we should expect when we are talking about biomedical moral enhancements. We suggest that a more grounded way to picture moral enhancement, at least in the near term, is to envision a form of cognitive enhancement that also provides some moral benefits by heightening the enhanced person's capability for acting according to their own subjective moral code. While this concept of moral adherence enhancement also has relevance for the moral enhancement discussion more widely, in this paper we apply it specifically in the context of space missions. We argue that there are weighty reasons to consider making biomedical enhancements of the proposed kind a mandatory feature of early-phase long-distance space travel because these missions are high-stakes in nature and take place in an environment where the enhancement could be seen as conferring important advantages while negating many of the traditional arguments weighed against it. • Psychosocial problems are significant on crewed long-distance space missions. • These missions are high-stakes in nature, at least in the early stages of space expansionism. • For such missions, cognitive enhancement for moral purposes is worth considering. • Our proposed form of enhancement is called moral adherence enhancement. [ABSTRACT FROM AUTHOR]

Background: In our multicultural society, as well as when working internationally, emergency physicians (EPs) frequently see patients from cultures with communitarian or hierarchal structures. These groups may rely on traditional medical practices and view health care decisions through a lens other than patient autonomy. This leads to uncertainty about who can legitimately make decisions for patients and how to apply basic ethical principles. Because the commonly taught ethical principles (autonomy, beneficence, nonmaleficence, and distributive justice) are loosely defined, they provide little help to EPs when working with cultures that de-emphasize Western individualism.Case Report: The case illustrates this complexity by detailing how visiting EPs dealt with leaders from a communitarian culture who demanded that a preteen be treated for a femur fracture by a traditional bone healer rather than with modern techniques.Discussion: The Western-trained clinicians struggled with their ethical responsibility to protect the child's welfare within the social setting: What should beneficence look like in this situation and to whom did it apply? More broadly, this paper examines the bases on which health care professionals might justify overruling parental decisions. It also asks whether the lack of clarity of the most used Western ethical principles suggests the need to broaden clinical ethics education to include issues from other cultures and settings.Conclusions: Despite principlism's shortcomings, the ease of teaching ethics to health care providers by grouping basic philosophical ideas suggests that we continue to use its structure. As educators and practitioners, we should, however, expand the concept of principlism to better address ethical values and issues found across different cultures. [ABSTRACT FROM AUTHOR]

Controlled organ donation after circulatory death (DCD) has recently been revived in the UK, as part of attempts to increase organ donation rates. The re-introduction of DCD has subsequently become the focus of bioethical controversy, since it necessitates intervening in the care of dying patients to obtain quality donor organs. Transplant policy responses to these concerns have generated new legal and ethical guidelines to address uncertainties around DCD, producing claims that the UK has overcome’ the ethical challenge of DCD. In contrast, by drawing on Lynch's call to ‘respecify’ ethics, this paper argues that ethics in DCD cannot be reduced to abstract directives for practice, but, instead, are composed and dealt with as an organisational problem. To do this, I utilise data from an ethnographic study examining the production of the ‘minority ethnic organ donor’ within UK organ donation settings; in particular, the data pertains to a case hospital which was in the process of developing a DCD programme during the period of fieldwork. Findings show that the ethics of DCD are encountered as practical sets of problems, constructed in relation to particular institutional locales. I describe how these issues are worked-around by creating conditions to make DCD organisationally possible, and through the animation of standard procedures into acceptable forms of practice. I argue that ethics in DCD go far beyond normative bioethical principles, to encompass concerns around: the reputation of hospital Trusts, public perceptions of organ donation, the welfare of potential donor families, and challenges to the work of health professionals caring for dying patients. The paper enriches understanding of ethics in science and medicine by showing how ethics are assembled and negotiated as a practical-organisational concern, and calls for further examination of how DCD gets constructed as a potential problem and is made to happen in practice. [ABSTRACT FROM AUTHOR]

Objectives Highlight the importance of teamwork in health care institutions by performing a review and discussion of the relevant literature. Study design Review paper. Methods A MEDLINE/Pubmed search was performed starting from 1990, and the terms 'team, teamwork, managers, healthcare, and cooperation' were searched in titles, abstracts, keywords, and conclusions; other terms 'patient safety, ethics, audits and quality of care' were specifically searched in abstracts and were used as additional filters criteria to select relevant articles. Results Thirty-three papers were found relevant; factors affecting the quality of care in health care institutions are multiple and varied, including issues related to individual profile, to administrative structure and to team-based effort. Issues affecting teamwork include mainly self-awareness, work environment, leadership, ethics, cooperation, communication, and competition. Moreover, quality improvement plans aiming to enhance and expand teams are essential in this context. Team monitoring and management are vital to achieve efficient teamwork with all the required qualities for a safer health system. In all cases, health managers' responsibility plays a fundamental role in creating and sustaining a teamwork atmosphere. Conclusion Teamwork is known to improve outcomes in medicine, whether at the clinical, organizational, or scientific level. Teamwork in health care institutions must increasingly be encouraged, given that individual effort is often insufficient for optimal clinical outcome. [ABSTRACT FROM AUTHOR]

Aim This perspective paper provides an overview of several key tensions and challenges within the social context of neuromodulation, and it suggests a means of securing the future of paediatric neuromodulation in light of these. Results Tensions and challenges relate to: the considerable clinical and economic need for new therapies to manage neurological diseases; significant commercial involvement in the field; funding pressures; public perceptions (particularly unrealistic expectations); and the emerging Responsible Research and Innovation initiative. This paper argues that managing these challenges and tensions requires that clinicians working within the field adopt what could be called a broad clinical gaze . This paper will define the broad clinical gaze, and it will propose several ways in which a broad clinical gaze can be – and indeed is being – operationalised in recent advances in neuromodulation in children. These include the use of multidisciplinary and interdisciplinary clinical team structures, the adoption of clinical assessment tools that capture day-to-day functionality, and the use of patient registries. Conclusion By adopting a broad clinical gaze, clinicians and investigators can ensure that the field as a whole can responsibly and ethically deliver on its significant clinical potential. [ABSTRACT FROM AUTHOR]

Modern advances in assisted reproduction technology (ART) have disrupted the traditional concept of parenthood. Every year, thousands of people travel abroad from their home countries in order to circumvent restrictive legislation or to benefit from lower fees. In a similar context, surrogacy raises many bioethical and legal issues. The present paper will address the main questions arising from the debate prompted by surrogacy, focusing on international legislation, and looking critically at the different legislative models. As a result of worldwide heterogeneity in policies, legal approaches, and access to ART throughout the world, a growing number of would-be parents are seeking treatment abroad. The lack of regulation on cross-border surrogacy in low income countries can undermine the dignity and rights of women as even modest economic compensation determines a significant purchasing power. The international effort should be aimed at creating an international regulatory framework from which guidelines useful to national governments derive. An international agreement would provide a solid legal basis for the protection of surrogate women. In order to limit the economic interests linked to procreative tourism, so as to truly protect global health and women's rights, legislative uniformity is therefore necessary between the various states. [ABSTRACT FROM AUTHOR]

The global political economy of stem cell therapies is characterised by an established biomedical hegemony of expertise, governance and values in collision with an increasingly informed health consumer demand able to define and pursue its own interest. How does the hegemony then deal with the challenge from the consumer market and what does this tell us about its modus operandi ? In developing a theoretical framework to answer these questions, the paper begins with an analysis of the nature of the hegemony of biomedical innovation in general, its close relationship with the research funding market, the current political modes of consumer incorporation, and the ideological role performed by bioethics as legitimating agency. Secondly, taking the case of stem cell innovation, it explores the hegemonic challenge posed by consumer demand working through the global practice based market of medical innovation, the response of the national and international institutions of science and their reassertion of the values of the orthodox model, and the supporting contribution of bioethics. Finally, the paper addresses the tensions within the hegemonic model of stem cell innovation between the key roles and values of scientist and clinician, the exacerbation of these tensions by the increasingly visible demands of health consumers, and the emergence of political compromise. [ABSTRACT FROM AUTHOR]

The rapid growth of the aquaculture sector over the past forty years can be closely linked to advances in science and technology. Some innovations in biotechnology have proven more controversial than others, and none more so than proposals for transgenic fish. Such innovations introduce concerns for the responsible governance of research and innovation for aquaculture, particularly in recognition of the significant uncertainties and high stakes characterising these technologies. This paper argues in favour of a participatory approach to the governance of contentious aquaculture technologies that includes an ‘upstream’ regard for their ethical and social implications. From this point of departure, the paper presents empirical research that employed one particular approach to engage aquaculture stakeholders from Northern Europe in deliberation over the ethical and social considerations of transgenic growth-enhanced salmon, using the ‘ethical matrix’ tool. This research explores the complexity of considerations raised by these small groups of diverse and knowledgeable stakeholders across workshops in Germany, Norway and the United Kingdom, and links them with wider ethical discussions in the bioethics literature. The dual ambitions of the paper are to first provide insights into an applied approach for incorporating ethical reasoning in processes for responsible aquaculture techno-innovation, and second to provide an appreciation for the plurality of considerations that decision-makers need to navigate and carefully weigh when reaching a decision on the appropriateness of the particular transgenic growth-enhanced salmon. [ABSTRACT FROM AUTHOR]

Organ transplants are not regarded as an exclusively medical process, because they involve financial, religious, philosophic, and bioethical parameters. It becomes clear that if they are to achieve their purpose, which we believe extends well beyond the medical dimension, the creation of a comprehensive framework of communication between the involved parties is of paramount importance. The aim of this paper is to present an outline and a number of considerations regarding the communicational, bioethical, and legal issues that arise from a rather dramatic state of affairs in Greece today: In 2012 the rate of organ transplants stood at only 7 per 1 million of the population. The outdated legal framework and the lack of trust on the part of patients and the public have led to a highly inefficient system that is lagging behind in many respects. The proposition made in this paper is that there is a need for a new system of communication between doctors, patients, relatives of patients, and hospitals: bioethical mediation. This is a system that has played a vital role and has produced astounding results in other countries. There is also every indication that the introduction of such a system is crucial for Greece, especially as the symptoms of the acute financial crisis are become fully visible and tangible. Mediation aims to identify solutions that are oriented toward the interests and wishes of patients, are acknowledged and accepted by all parties involved, and are in tune with the values and the principles of medical practice. [ABSTRACT FROM AUTHOR]

The US is facing dual public health crises related to opioid overdose deaths and HIV. Injection drug use is fueling both of these epidemics. The War on Drugs has failed to stem injection drug use and has contributed to mass incarceration, poverty, and racial disparities. Harm reduction is an alternative approach that seeks to decrease direct and indirect harms associated with drug use without necessarily decreasing drug consumption. Although overwhelming evidence demonstrates that harm reduction is effective in mitigating harms associated with drug use and is cost-effective in providing these benefits, harm reduction remains controversial and the ethical implications of harm reduction modalities have not been well explored. This paper analyzes harm reduction for injection drug use using the core principles of autonomy, nonmaleficence, beneficence, and justice from both clinical ethics and public health ethics perspectives. This framework is applied to harm reduction modalities currently in use in the US, including opioid maintenance therapy, needle and syringe exchange programs, and opioid overdose education and naloxone distribution. Harm reduction interventions employed outside of the US, including safer injection facilities, heroin-assisted treatment, and decriminalization/legalization are then discussed. This analysis concludes that harm reduction is ethically sound and should be an integral aspect of our nation's healthcare system for combating the opioid crisis. From a clinical ethics perspective, harm reduction promotes the autonomy of, prevents harms to, advances the well-being of, and upholds justice for persons who use drugs. From a public health ethics perspective, harm reduction advances health equity, addresses racial disparities, and serves vulnerable, disadvantaged populations in a cost-effective manner. [ABSTRACT FROM AUTHOR]

Moral distress is a pervasive phenomenon that can negatively impact healthcare professionals and has been well studied in nursing populations. Much of the evidence suggests that it is associated with intention to leave high acuity areas and the profession. Despite the increasing amounts of research to explore the causes and effects of moral distress, there is limited research on interventions that mitigate the negative effects of moral distress. The aims of this systematic review were to: (a) identify and examine interventions developed to address moral distress experienced by health care professionals (b) examine the quality of the research methods and (c) report on the efficacy of these interventions. We conducted a systematic review of interventional studies developed to mitigate moral distress. Medline, Embase, PsycINFO, CINAHL and Cochrane were searched for relevant studies (July 2019- September 2019). Additional bioethics databases and reference lists were also hand-searched. The first author reviewed all retrieved titles and abstracts with a low tolerance for borderline papers based on inclusion and exclusion criteria, and those papers were reviewed and discussed by all authors to determine inclusion. Quality appraisal was conducted on the included studies using narrative synthesis to compare the findings. Data were extracted and compared by all authors and then reviewed by the first author for consistency. Sixteen papers were included for full text review and the following interventions identified: educational interventions of varying length and breadth; facilitated discussions ranging from 30 to 60 minutes; specialist consultation services; an intervention bundle; multidisciplinary rounds; self-reflection and narrative writing. Researchers reported statistically significant reductions in moral distress using pre and post surveys, including one mixed methods program evaluation (n=7). The qualitative program evaluation provided participant quotations to suggest their program was beneficial. There were no statistically significant findings in the other studies (n=8). All studies had limitations in design and methodology presenting significant threats to validity. Designing rigorous research studies that measure the impact of interventions aimed at mitigating moral distress continues to be challenging. The primary reason being that moral distress is a subjective ethical phenomenon with a number of different causes and effects. This calls for interventions that are flexible and sensitive to individual's needs. To build an evidence-base, interventions should also be measurable and research methods need to be scientifically rigorous. To achieve rigor and innovation, researchers should clearly justify their methodological choices. Tweetable abstract: Interventions to mitigate moral distress: a systematic review of the literature. Educational interventions offer a promising direction but more research is needed. [ABSTRACT FROM AUTHOR]

It has already become a commonplace to discuss postbiological evolution in various contexts of futures studies, bioethics, cognitive sciences, philosophical anthropology, or even economics and SETI studies. The assumption is that technological/cultural evolution will soon entirely substitute for the biological processes which underlie human existence – and, by analogy, the existence of other independently evolved intelligent beings, if any. Various modes of postbiological evolution of humans have been envisioned in both fictional and discursive contexts (uploading, cyborgization, technological singularity, etc.). Little thought has been devoted so far to the question whether these postbiological modes are truly final in both logical and conceptual terms. What lies beyond the postbiological realm? Clearly, only a few radical speculations on the topic can be offered. In this paper, it is argued that in a sufficiently broad subset of scenarios for postbiological evolution there will be a kind of reverse trend: the one of reintegration with the (astro)biological universe, by that point understood in a much wider and more inclusive sense. The argument for such reintegration could be understood through the metaphor of expanding Klein bottle as a symbolic image of the post-postbiological evolutionary trajectories. This kind of trajectory will lead to the state in which products of culture are indistinguishable from the natural environment, suggesting practical consequences for our SETI efforts. [ABSTRACT FROM AUTHOR]

Resumo Justificativa e objetivos Os pacientes testemunhas de Jeová recusam transfusão sanguínea por motivos religiosos. O anestesiologista deve dominar conhecimentos jurídicos específicos para atender esses pacientes. Entender como o direito e o Conselho Federal de Medicina tratam essa questão é fundamental para saber agir dentro desse contexto. O objetivo deste artigo foi estabelecer um protocolo de atendimento do paciente testemunha de Jeová com ênfase no dever ético e legal do anestesiologista. Conteúdo O artigo analisa a Constituição, o Código Penal, resoluções do Conselho Federal de Medicina (CFM), pareceres e jurisprudência para entender os limites do conflito entre a autonomia de vontade da testemunha de Jeová em recusar transfusão e a obrigação do médico em transfundir. Baseado nessas evidências um protocolo de atendimento é sugerido. Conclusões A resolução do CFM 1021/1980, o Código Penal no artigo 135, que classifica como crime a omissão de socorro, e a decisão do Supremo Tribunal de Justiça sobre o processo HC 268.459/SP impõem ao médico a obrigação de transfusão quando houver risco de vida. Não é necessário concordância do paciente ou de seu responsável, pois não é proibida a manifestação de vontade do paciente testemunha de Jeová ao recusar transfusão sanguínea para si e seus dependentes, mesmo em emergências. Background and objectives Jehovah's Witnesses patients refuse blood transfusions for religious reasons. Anesthesiologists must master specific legal knowledge to provide care to these patients. Understanding how the Law and the Federal Council of Medicine treat this issue is critical to know how to act in this context. The aim of this paper was to establish a treatment protocol for the Jehovah's Witness patient with emphasis on ethical and legal duty of the anesthesiologist. Content The article analyzes the Constitution, Criminal Code, resolutions of the Federal Council of Medicine (FCM), opinions, and jurisprudence to understand the limits of the conflict between the autonomy of will of Jehovah's Witnesses to refuse transfusion and the physician's duty to provide the transfusion. Based on this evidence, a care protocol is suggested. Conclusions The FCM resolution 1021/1980, the penal code Article 135, which classifies denial of care as a crime and the Supreme Court decision on the HC 268,459/SP process imposes on the physician the obligation of blood transfusion when life is threatened. The patient's or guardian's consent is not necessary, as the autonomy of will manifestation of the Jehovah's Witness patient refusing blood transfusion for himself and relatives, even in emergencies, is no not forbidden. [ABSTRACT FROM AUTHOR]

Migration is a significant feature of the political discourse around the world. It is bewildering and polarizing policy makers, leaders and communities, grappling to address the questions raised. The growing body of empirical data on migrant health have profound ethical relevance for example around risk-benefit-analysis, justice and discrimination at the individual, micro, meso and macro levels. The policy decisions and actions to address the issues appear to be often guided by self-interest and increasing pressures to protect national interests, and the current structures and systems. This paper briefly outlines and reflects on the ethical dimensions of migration, diversity and health and implications for policy, and practice. We argue that there is a case for new paradigms of global solidarity, social justice, and health equity in an interconnected world. Health care for migrants should be built on values of equal human rights and of shared humanity and the health and wellbeing of migrants and citizens should be promoted and protected alike. Migrant health is of global concern and international strategies for global governance are required. Migration policies it is suggested should be based on the understanding of interconnectedness of our societies and founded on shared humanity, and health equity for all. There is a case to reimagine the earth as one country and humankind its citizens with its implications on policy and practice and the organized efforts of society. [ABSTRACT FROM AUTHOR]

Embryos have different meanings for different people and in different contexts. Seen under the microscope, the biological embryo starts out as one cell and then becomes a bunch of cells. Gradually these divide and differentiate to make up the embryo, which in humans becomes a fetus at eight weeks, and then eventually a baby. At least, that happens in those cases that carry through normally and successfully. Yet a popular public perception imagines the embryo as already a little person in the very earliest stages of development, as if it were predictably to become an adult. In actuality, cells can combine, pull apart, and recombine in a variety of ways and still produce embryos, whereas most embryos never develop into adults at all. Biological embryos and popular imaginations of embryos diverge. This paper looks at some of the historical reasons for and social implications of that divergence. [ABSTRACT FROM AUTHOR]

Background: Biopiracy mainly focuses on the use of biological resources and/or knowledge of indigenous tribes or communities without allowing them to share the revenues generated out of economic exploitation or other non-monetary incentives associated with the resource/knowledge.Methods: Based on collaborations of scientists from five continents, we have created a communication platform to discuss not only scientific topics, but also more general issues with social relevance. This platform was termed 'PhytCancer -Phytotherapy to Fight Cancer' (www.phyt-cancer.uni-mainz.de). As a starting point, we have chosen the topic "biopiracy", since we feel this is of pragmatic significance for scientists working with medicinal plants.Results: It was argued that the patenting of herbs or natural products by pharmaceutical corporations disregarded the ownership of the knowledge possessed by the indigenous communities on how these substances worked. Despite numerous court decisions in U.S.A. and Europe, several international treaties, (e.g. from United Nations, World Health Organization, World Trade Organization, the African Unity and others), sharing of a rational set of benefits amongst producers (mainly pharmaceutical companies) and indigenous communities is yet a distant reality. In this paper, we present an overview of the legal frameworks, discuss some exemplary cases of biopiracy and bioprospecting as excellent forms of utilization of natural resources.Conclusions: We suggest certain perspectives, by which we as scientists, may contribute towards prevention of biopiracy and also to foster the fair utilization of natural resources. We discuss ways, in which the interests of indigenous people especially from developing countries can be secured. [ABSTRACT FROM AUTHOR]

The issue of balance between research and treatment in clinical trials conduct has been surrounded by controversies. Scientific characteristics of trials may compromise medical care available to participants, while conceiving research participation as having therapeutic value may foster the therapeutic misconception. However, it has also been questioned whether research can and should always be separated from medical care provision. In this paper we analyze how these concerns played out in practice settings of the three trial sites in Russia, specialized in trials in cardiovascular diseases. Using in-depth interviews with participants of phase II and III trials (n = 21) and discussions with physician-investigators (n = 7), we found that trial enrollment allowed participants to establish continuous supportive relationships with the physician-investigators. In the context of unresponsive health care, chronically ill participants received regular monitoring, treatment recommendations and help in case of problems and emergencies through such relationships. The trial designs in the three sites did not preclude the provision of individualized treatment. We suggest that debates about the research/treatment interface in trials need to become more attuned to the conditions in locations of their conduct, views and experiences of actors involved and evolving trial methodologies. Too much focus on categorical differentiation of research and treatment may obscure the fact that globalizing clinical trials proceed amidst profound health disparities, dismiss diverse concerns of people on the ground and risk attenuating responsibilities of trial organizers, sponsors and investigators towards research participants. [ABSTRACT FROM AUTHOR]

Objectives To provide foundational knowledge about approaches to ethical decision-making that arise as part of palliative care of cancer patients and their families. Data Source Journal articles, research reports, state and federal regulations, professional codes of ethics and state of the science papers. Conclusion More and more, cancer deaths occur after a long progressive illness, requiring ongoing goals of care discussion and a focus on joint decision-making. No matter how diverse the community or how advanced the healthcare setting, the needs, preferences, and values of the patient and family will continue to be at the core of palliative care. Implications for Nursing Practice The increasingly complex healthcare environment makes it essential that nurses have an understanding of medical ethics and relevant federal and state laws so that this knowledge can be applied to the many issues arising in palliative and end-of-life care. [ABSTRACT FROM AUTHOR]

Introduction: Recent developments in the field of Artificial Intelligence (AI) applied to healthcare promise to solve many of the existing global issues in advancing human health and managing global health challenges. This comprehensive review aims not only to surface the underlying ethical and legal but also social implications (ELSI) that have been overlooked in recent reviews while deserving equal attention in the development stage, and certainly ahead of implementation in healthcare. It is intended to guide various stakeholders (eg. designers, engineers, clinicians) in addressing the ELSI of AI at the design stage using the Ethics by Design (EbD) approach.Methods: The authors followed a systematised scoping methodology and searched the following databases: Pubmed, Web of science, Ovid, Scopus, IEEE Xplore, EBSCO Search (Academic Search Premier, CINAHL, PSYCINFO, APA PsycArticles, ERIC) for the ELSI of AI in healthcare through January 2021. Data were charted and synthesised, and the authors conducted a descriptive and thematic analysis of the collected data.Results: After reviewing 1108 papers, 94 were included in the final analysis. Our results show a growing interest in the academic community for ELSI in the field of AI. The main issues of concern identified in our analysis fall into four main clusters of impact: AI algorithms, physicians, patients, and healthcare in general. The most prevalent issues are patient safety, algorithmic transparency, lack of proper regulation, liability & accountability, impact on patient-physician relationship and governance of AI empowered healthcare.Conclusions: The results of our review confirm the potential of AI to significantly improve patient care, but the drawbacks to its implementation relate to complex ELSI that have yet to be addressed. Most ELSI refer to the impact on and extension of the reciprocal and fiduciary patient-physician relationship. With the integration of AIbased decision making tools, a bilateral patient-physician relationship may shift into a trilateral one. [ABSTRACT FROM AUTHOR]

There is considerable concern about increasing rates of anxiety and depression among children and young people (CYP). Mental health technologies, such as smartphone applications, are proposed as a potential solution. However, the effectiveness of mental health mobile applications for managing, moderating and treating anxiety and depression in CYP is uncertain. The purpose of this scoping review is to outline the extent of the clinical evidence base of mental health apps with monitoring functions for depression and anxiety in CYP, to categorise the range of monitoring features, to understand their various purposes, and to analyse these 'technical mechanisms' in apps from the perspective of critical ecological analysis. It provides a novel conceptual framework for researching how CYP may use and critically engage with mental health apps. We searched Ovid MEDLINE, PsycINFO, and Scopus databases, and 39 studies met the inclusion criteria. The analysis focuses attention on the ecological (mental, social and environmental) dimensions of life, health and emotional experience and the purposes of mental health monitoring apps. We evaluate the way that technical mechanisms , such as metrics are used in apps, examine their effects on responsibility for managing and treating distress and consider the rationalities that guide their development. The paper concludes that examination of the bioethics and neuroethics of these technologies is necessary and urgent. This requires paying closer attention to the social practices of technology-enabled self-monitoring, and the ways in which these frame mental health as a form of individualised emotional regulation. • Scoping review of apps for anxiety and depression for children and young people. • Provides typology and critical ecological analysis of mental health monitoring apps. • Effectiveness of mental health monitoring apps is uncertain. • Apps are not discrete 'tools', need to look at the contexts of their usage. • Monitoring apps reshape responsibilities for managing and treating distress. [ABSTRACT FROM AUTHOR]

• Human enhancement for future space missions is a reasonable option. • Different methods of human enhancement for space include gene editing or implants. • Ethics should support a careful application of human enhancement for space missions. Future human space missions to Mars and beyond may be realized for different research, economic, political or survival reasons. Since space remains a hazardous environment for humans, space exploration and exploitation requires the development and deployment of effective countermeasures. In this paper, we discuss prospects for human enhancement by gene editing, synthetic biology, or implants, for the purposes of future space missions. We argue that there are good reasons to consider such options, and that ethical arguments can be made in favor of human enhancement to enable long-term space exploration. [ABSTRACT FROM AUTHOR]

Genetics, as a discipline, is an essential part of the modern world. However, analyzing the interaction between genetics and society can be complex. Therefore, terminology has arisen from diverse fields to better understand genetics and its relation to other domains. Nevertheless, the diverse origins of many of these terms, as well as a lack of clarity in their definitions, have led to differences in use. This paper focuses on four such terms: genetic fetishism, geneticization, genetic essentialism, and genetic exceptionalism. By clarifying what each term means, the fields that utilize them will be helped. Furthermore, these terms can have specific value to bioethics in analyzing ethical issues that arise from genetics and the interaction with the socio-cultural world. While these terms may not always be applicable, a more careful analysis of their meaning can cultivate a more scientific and rigorous analysis of the ways genetics impacts and is understood by humanity. [ABSTRACT FROM AUTHOR]

Perhaps the two most significant pioneering biomedical discoveries with immediate clinical implications during the past forty years have been the advent of assisted reproductive technologies (ART) and the genetics revolution. ART, including in vitro fertilization (IVF), intracytoplasmic sperm injection and preimplantation genetic testing, has resulted in the birth of more than 8 million children, and the pioneer of IVF, Professor Bob Edwards, was awarded the 2010 Nobel Prize. The genetics revolution has resulted in our genomes being sequenced and many of the molecular mechanisms understood, and technologies for genomic editing have been developed. With the combination of nearly routine ART protocols for healthy conceptions together with almost error-free, inexpensive and simple methods for genetic modification, the question " Are we ready for genome editing in human embryos for clinical purposes? " was debated at the 5th congress on controversies in preconception, preimplantation and Prenatal Genetic Diagnosis, in collaboration with the Ovarian Club Meeting, in November 2018 in Paris. The co-authors each presented scientific, medical and bioethical backgrounds, and the debate was chaired by Professor Alan Handyside. In this paper, we consider whether genome editing is safe and ethical. We conclude that we are currently not ready for genome editing to be used in human embryos for clinical purposes, and we call for a global debate to determine if and when this technology could be used in ART. ‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬‬ [ABSTRACT FROM AUTHOR]