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The race against COVID-19 has been intense and painful and many of us are now looking for a way to move on. We may try to seize a degree of comfort and security by convincing ourselves that we are among the "fittest"—that is, among those who have managed to survive—who can now hope for a "new-normal" time, relatively unscathed. But this isn't what we should be hoping for. Our world, and ourselves, will never be free of COVID-19 or its insidious effects. COVID-19, like climate change, is a threat multiplier and the challenges it has raised are now indelibly engraved in our vulnerable, interconnected lives. Rather than vainly hoping for a return to an imaginary, erstwhile "normal" what we need is something more fundamental: a new version of hope that embraces a courage to learn what we need to do, to enable us to live a future to which we aspire. Perhaps counter-intuitively, we need to accept that the COVID-19 experience has already changed us deeply and hope that we can learn from this and from the future changes that the pandemic will give rise to. We need to radicalize our responses to the challenges, enabling ourselves to learn new lessons about old but increasingly pertinent topics, such as the realities of human fragility, and inter-connection. [ABSTRACT FROM AUTHOR]

Intense public interest in scientific claims about COVID-19, concerning its origins, modes of spread, evolution, and preventive and therapeutic strategies, has focused attention on the values to which scientists are assumed to be committed and the relationship between science and other public discourses. A much discussed claim, which has stimulated several inquiries and generated far-reaching political and economic consequences, has been that SARS-CoV-2 was deliberately engineered at the Wuhan Institute of Virology and then, either inadvertently or otherwise, released to the public by a laboratory worker. This has been pursued despite a clear refutation, through comprehensive genomic analysis, of the hypothesis that the virus was deliberately engineered and the failure of detailed investigations to identify any evidence in support of a laboratory leak. At the same time a substantial, established body of knowledge about the many factors underlying the emergence of novel zoonotic diseases has been largely ignored—including climate change and other mechanisms of environmental destruction, tourism, patterns of trade, and cultural influences. The existence and conduct of these debates have raised questions about the vulnerability of science to manipulation for political purposes. Scientific discourses are vulnerable because: (i) claims can be made with no more than probabilistic force; (ii) alleged "facts" are always subject to interpretation, which depends on social, ethical, and epistemological assumptions; and (iii) science and scientists are not inherently committed to any single set of values and historically have served diverse, and sometimes perverse, social and political interests. In the face of this complexity, the COVID-19 experience highlights the need for processes of ethical scrutiny of the scientific enterprise and its strategic deployment. To ensure reliability of truth claims and protection from corrupting influences robust ethical discourses are required that are independent of, and at times even contrary to, those of science itself. [ABSTRACT FROM AUTHOR]

Opinion statement: In considering the impact of medically hastened death (MHD) on cancer care, a wide range of variables needs to be considered including demographic factors, diagnoses, local cultural factors, and the legislative frameworks in place. Here, we present a synthesis of recently available published literature and empirical data collected following legislative change to enable MHD in Victoria, Australia to explore in detail the potential impact of MHD on cancer care with a focus on patients/families and professional groups. Our findings reveal that for patients and families, both physical and existential distress frequently underlie MHD requests, with the latter less readily recognised by health professionals. The responses of those around the patient making the request may have a very significant impact on relationships within families and upon the nature of the subsequent bereavement. For palliative care, while differing views may remain, it appears that there has been some accommodation of MHD into or alongside practice over time. The recognition of a shared commitment to relief of suffering of palliative care and MHD appears a helpful means of establishing how these practices may co-exist. In cancer practice more broadly, as individual professionals reflect upon their own roles, new relationships and pathways of patient movement (or referral) must be established in response to patients' requests. Our findings also highlight many unanswered questions in understanding the impact of MHD, including that upon those dying who choose not to access MHD, First Nations peoples, the participating health professionals' longer term, and the relief of suffering itself. A systematic approach to the evaluation of MHD legislation must be adopted in order to understand its full impact. Only then could it be determined if the aspirations for such legislative change were being met. [ABSTRACT FROM AUTHOR]

Purpose: In hospital settings, patients, visitors, and staff engage in many interactions outside formal clinical encounters. Whilst many of these may be inconsequential, others contribute significantly to how patients and their carers experience cancer and its treatment. This article aims to explore the experiences and significance of interactions that occur outside formal clinical encounters in hospital cancer treatment settings. Methods: Semi-structured interviews were conducted with cancer patients, carers, and staff recruited from two hospital sites and cancer support groups. Hermeneutic phenomenology informed lines of questioning and data analysis. Results: Thirty-one people participated in the study: 18 cancer patients, four carers, and nine staff members. The experiences of informal interactions were grouped into three themes: connecting, making sense, and enacting care. The participants described how these encounters allowed connection with others in the hospital spaces, facilitating a sense of belonging, normality, and self-worth. Through these interactions, individuals participated in making sense of their experiences, to better anticipate the decisions and challenges that might lie ahead. By connecting with other individuals, they cared for others and felt cared for themselves, and were able to learn from, teach, and support each other. Conclusions: Outside the confines of the clinical discourses participants negotiate terms of engagement, sharing of information, expertise, and their own personal stories that they may employ to contribute to the individuals around them. These interactions occur within a loose and evolving framework of social interactions, an ‘informal community’, in which cancer patients, carers, and staff members play active and meaningful roles. [ABSTRACT FROM AUTHOR]

Gerrit Lindeboom's biography, Herman Boerhaave: The Man and His Work, presents a heroic account of Herman Boerhaave's life and his many contributions to medicine and medical education. He is portrayed as an outstanding eighteenth century educator who introduced into Leiden's Medical School a novel method of clinical teaching that was to be widely adopted and today remains at the centre of medical student instruction. Lindeboom's historiography induced a resurgence of interest in Boerhaave, a renewal of the myth concerning Boerhaave's innovative teaching and the publication of many acclamatory articles and false epithets, and several critical analyses. Such varying responses prompted this critical examination of the extant Boerhaavian literature, an appraisal of Lindeboom's objectivity and an assessment of his representations of Boerhaave's clinical teaching. In doing so, the moral nature of his historiography and that of those who were to sustain his assertions will be established, and the myth that surrounds the novelty and excellence of Boerhaave's clinical teaching will be evident. [ABSTRACT FROM AUTHOR]

This article reflects on the assumption underlying the argument of Little et al. that "contested understandings" in the clinic are susceptible to reconciliation within a liberal framework described as "pragmatic pluralism". It is argued that no such reconciliation is possible or desirable because it is of the nature of the clinic that it provides a forum for multiple voices, ethical and cultural perspectives, and conceptual frameworks, and this is the source of its fecundity and creativity. Medicine itself cannot be represented by a single discourse, precisely because it is itself an unruly collection of practices that, despite their heterogeneity, are able to engage in productive dialogues with each other. The heteroglossia of the clinic, therefore, is not a problem to be overcome. Rather, it is a rich resource to be mobilized in accordance with its multiple inherent purposes. [ABSTRACT FROM AUTHOR]

Like other Arab countries, Jordan must find ways of responding to the rapid processes of change affecting many aspects of social life. This is particularly urgent in healthcare, where social and technical change is often manifested in tensions about ethical decision-making in the clinic. To explore the attitudes, beliefs and concerns relating to ethical decision-making among health professionals in Jordanian hospitals, a qualitative study was conducted involving face-to-face interviews with medical personnel in four hospitals in Amman, the capital of Jordan. Data were analysed thematically in relation to a pre-existing set of ethical categories. Interviews were conducted with thirty-eight doctors covering most medical specialities. Five major themes emerged from the interviews: ethical awareness, ethical issues, the impact of religion on ethical decision-making, practical and theoretical resources for ethical decision-making, and challenges. While uncertainty was expressed about some aspects of Western approaches to ethics, participants strongly supported adoption of a range of Western bioethical principles, including cultural and ethical diversity, along with adherence to Islamic religious norms. A range of serious ethical challenges facing the Jordanian health system were identified, covering social, legal, managerial, and technical issues. Ethical decision-making in Jordan is complex, having to accommodate the needs of patients, the opinions of doctors and their families, the views of religious authorities, managerial considerations, and both local norms and international standards. Health professionals struggle with three sets of tensions that emerge out of the struggle between traditional, community-embedded forms of social organization and the demands generated by globalization and the influence of Western culture: the tensions between tradition and modernity, conservatism and pragmatism, and religion and secularism. Doctors in Jordan prefer approaches to ethical decision-making that realize a balance between the extremes, although the exact nature of where that balance should lie remains uncertain. [ABSTRACT FROM AUTHOR]

This historiographic survey of extant English translations and interpretations of the renowned Hippocratic first aphorism has demonstrated a concerning acceptance and application of ancient deontological principles that have been used to justify a practice of medicine that has been both paternalistic and heteronomous. Such principles reflect an enduring Hippocratism that has perpetuated an insufficient appreciation of the moral nature of the aphorism's second sentence in the practice of the art of medicine. That oversight has been constrained by a philological discourse that has centred on the meanings of the aphorism's first sentence, while little consideration has been given to the more important ethical consideration within the second sentence's imperatives. [ABSTRACT FROM AUTHOR]

The focus of discussion about the ethical issues associated with the COVID-19 pandemic has been on the great suffering to which it has given rise. However, there may be some unexpected positive outcomes that also emerge from the global disaster. The rupturing of entrenched systems and processes, the challenging of certainties that seemed beyond question, and the disruption of the assumed consensus of modernity may contribute to a rediscovery of the challenges that compose an ethical life. Elements of such a process are evident in the surge of community support and mutual caring, of spontaneous acts of joyous solidarity, of suspension of past conflicts, and exploration of new forms of reconciliation. The experiences are tentative and the outcomes uncertain, but at least for a moment the hope of a new way forward has been raised. [ABSTRACT FROM AUTHOR]

Surveillance is a core function of all public health systems. Responses to the COVID-19 pandemic have deployed traditional public health surveillance responses, such as contact tracing and quarantine, and extended these responses with the use of varied technologies, such as the use of smartphone location data, data networks, ankle bracelets, drones, and big data analysis. Applying Foucault's (1979) notion of the panopticon, with its twin focus on surveillance and self-regulation, as the preeminent form of social control in modern societies, we examine the increasing levels of surveillance enacted during this pandemic and how people have participated in, and extended, this surveillance, self-regulation, and social control through the use of digital media. Consideration is given to how such surveillance may serve public health needs and/or political interests and whether the rapid deployment of these extensive surveillance mechanisms risks normalizing these measures so that they become more acceptable and then entrenched post-COVID-19. [ABSTRACT FROM AUTHOR]

This review essay examines the emergence of the patient narrative or "pathography" in the late eighteenth and early nineteenth century in relation to the great cultural, epistemological, and ethical transformations that enabled the formation of modern medicine. John Wiltshire's book provides an historical overview of this complex process, as well as laying the basis for a contemporary critique of some of its key assumptions. [ABSTRACT FROM AUTHOR]

The Arab and Islamic world is in cultural, political and ethical flux. Pressures of globalisation contend with ancient ideas and concepts that permeate cultural frameworks. Health professionals are among the many groups battling to accommodate the rapidly changing conditions. In many predominantly Muslim countries intense debates are underway among clinicians about the impact of the forces of change on their practices. To help understand these forces we conducted a study of the experiences of clinicians in the Hashemite Kingdom of Jordan, a Middle Eastern nation state where the overwhelming majority of the population is Muslim. The sample contained 508 doctors and doctors-in-training, of whom 63% were male and 80% were younger than 40 years of age. It included both a quantitative survey, covering a wide range of issues, and qualitative, free-text written responses. Our results demonstrated high levels of disquiet related to the overall organisation and administration of the health care system, the specific content of ethical decisionmaking, and the impact of changing social, cultural and religious factors. Concerns included overcrowding, widespread corruption and hierarchical, non- democratic, management practices, and tensions relating to traditional and modern approaches to ethics, especially in relation to consent, organ donation, confidentiality, privacy, abortion, and the role of women. The roles of religion and religious authorities, the relative importance of the family, and community and tribal obligations were also areas of contention. The study exposes profound divisions and widely differing perspectives among Jordanian doctors and an abiding sense of uncertainty and instability within the profession. Many doctors express ambivalence in relation to both modern trends and traditional precepts. Three main axes of ethical contention were demonstrated, relating to the tensions between: "conservative" and "pragmatic" styles of decision-making; "traditional" approaches and internationalised standards of ethics; and the role of Islam and pressures to disengage ethical decision- making from religious authority. We speculate that these issues and divisions, and the deep sense of disquiet revealed by our data reflect large-scale forces to which Jordanian society is exposed and to a substantial degree may provide a way to understand the ethical predicament of many other countries in the contemporary Arab world. [ABSTRACT FROM AUTHOR]

Learning from the profound challenge of dementia is an urgent priority. Success will require a critical deconstruction of current cultural and linguistic representations of this condition, and a kindling of novel and courageous approaches to re-conceptualise dementia's meaning and experience. This symposium collects provocative ideas arising from various discourses, theoretical perspectives, and methodolgical approaches to explore new ways to understand dementia. [ABSTRACT FROM AUTHOR]

Dementia is more than a disease. What dementia is, how it is understood, and how it is experienced is influenced by multiple factors including our societal preoccupation with individual identity. This essay introduces empirical and theoretical evidence of alternative ways of understanding dementia that act as a challenge to common assumptions. It proposes that dementia be understood as an experience of systems, particularly networks of people affected by the diagnosis. Taking this step reveals much about the dementia experience, and about what can be learned from persons with dementia and their networks of family, friends, and carers. It also suggests that dementia may be best thought of as an ecology that arises from the interaction between neuropathological change, people, language, and meaning. While challenging, this perspective may provide new ways of responding to dementia and caring for those affected by it. [ABSTRACT FROM AUTHOR]

Recognizing the potential hidden artistic contributions of persons with dementia opens new opportunities for interpretation and potential communication. This visual essay explores the authors' responses to the fragile objects of art produced by a person with severe dementia and examines what may be learned from them. [ABSTRACT FROM AUTHOR]

Vaccination is a highly effective public health strategy that provides protection to both individuals and communities from a range of infectious diseases. Governments monitor vaccination rates carefully, as widespread use of a vaccine within a population is required to extend protection to the general population through “herd immunity,” which is important for protecting infants who are not yet fully vaccinated and others who are unable to undergo vaccination for medical or other reasons. Australia is unique in employing financial incentives to increase vaccination uptake, mainly in the form of various childcare payments and tax benefits linked to timely, age-appropriate vaccination. Despite relatively high compliance with the childhood vaccination schedule, however, the Australian government has determined that rates should be higher and has recently introduced policy that includes removing certain tax and childcare benefits for non-vaccinators and formally disallowing conscientious objection to vaccination (“No Jab No Pay”). In addition, it has raised the possibility of banning unvaccinated children from childcare centres (“No Jab No Play”). This article examines the impact of coercive approaches to childhood vaccination and raises the question of the ethical justification of health policy initiatives based on coercion. We consider the current evidence regarding childhood vaccination in Australia, the small but real risks associated with vaccination, the ethical requirement for consent for medical procedures, and the potential social harms of targeting non-vaccinators. We conclude that the evidence does not support a move to an increasingly mandatory approach that could only be delivered through paternalistic, coercive clinical practices. [ABSTRACT FROM AUTHOR]

Social, political, and economic environments play an active role in nurturing professional virtue. Yet, these environments can also lead to the erosion of virtue. As such, professional virtue is fragile and vulnerable to environmental shifts. While physicians are often considered to be among the most virtuous of professional groups, concern has also always existed about the impact of commercial arrangements on physicians' willingness and capacity to enact their professional virtues. This article examines the ways in which commercial arrangements have been negotiated to secure medical virtue from real or perceived threats of erosion. In particular, we focus on the concern surrounding conflicts of interest arising from commercial arrangements that have developed as a result of neoliberal economic and social policies. The deregulation of medical markets and privatization of services have produced new commercial relationships that are often misunderstood by patients, publics, and physicians themselves. 'Conflicts of interest' policies have been introduced in an attempt to safeguard ethical conduct and medical practice. However, a number of virtue ethicists have critiqued these policies as inadequate for securing virtue. We examine the ways in which commercial arrangements have been seen to impact upon medical virtue, both historically and in the context of modern medicine (using the example of fertility services in Australia). We then describe and critique current efforts to restore clinical virtue through both conflict of interest policies and through virtue ethics. Finally, we suggest some possible ways of addressing the corrosive effects of neoliberalism on medical virtue. [ABSTRACT FROM AUTHOR]

Recent discourses about the legitimacy of homeopathy have focused on its scientific plausibility, mechanism of action, and evidence base. These, frequently, conclude not only that homeopathy is scientifically baseless, but that it is 'unethical.' They have also diminished patients' perspectives, values, and preferences. We contend that these critics confuse epistemic questions with questions of ethics, misconstrue the moral status of homeopaths, and have an impoverished idea of ethics-one that fails to account either for the moral worth of care and of relationships or for the perspectives, values, and preferences of patients. Utilitarian critics, in particular, endeavour to present an objective evaluation-a type of moral calculus-quantifying the utilities and disutilities of homeopathy as a justification for the exclusion of homeopathy from research and health care. But these critiques are built upon a narrow formulation of evidence and care and a diminished episteme that excludes the values and preferences of researchers, homeopaths, and patients engaged in the practice of homeopathy. We suggest that homeopathy is ethical as it fulfils the needs and expectations of many patients; may be practiced safely and prudentially; values care and the virtues of the therapeutic relationship; and provides important benefits for patients. [ABSTRACT FROM AUTHOR]

The last two decades have seen remarkable advances in and acceptance of bariatric surgery. These advances include quality assurance, certification of surgeons and their institutions and the development of national bariatric registries. Yet, in spite of these advances, an urgent need to improve ethical standards in bariatric surgery remains. In particular, surgical innovation must be subjected to adequate scrutiny and sufficient safeguards. New procedures and the processes by which they are assessed should be subject to review and approval by the ethics committees operating under clearly defined guidelines. The public must be able to have confidence that the surgery itself, and the innovative practices that are introduced within it, are not subject to distortions associated with personal, wider professional, industry or institutional interests. [ABSTRACT FROM AUTHOR]

Introduction: Second medical opinions (SMOs) are common in oncology practice, but the nature of these consultations has received relatively little attention. This study examines the views of patients with advanced cancer and their physicians of SMOs.Method: Parallel, concurrent surveys were developed for patients and physicians. The first was distributed to outpatients with advanced cancer-attending specialist clinics in an Australian quaternary hospital. The second survey, developed on the basis of results of exploratory interviews with medical oncologists, was distributed to medical oncologists in Australia.Results: Seventeen of fifty two (33%) patients had sought a SMO, most commonly prompted by concerns around communication with their first doctor, the extreme and desperate nature of their medical condition and the need for reassurance. Most (94%) patients found the SMO helpful, with satisfaction related to improved communication and reassurance. Patients were concerned that seeking a second medical opinion may affect their relationship with their primary doctor. Most physicians (82%) reported seeing between one and five SMO per month, with patients being motivated by the need for additional information and reassurance. Physicians regarded SMO patients as having greater information needs (84%), greater psychosocial needs (58%) and requiring more of the physician's time and energy (77%) than other patients.Conclusion: SMOs are common in cancer care with most patients motivated by the need for improved communication, additional information and reassurance. Physicians identify patients who seek SMOs as having additional psychosocial needs compared with other oncology patients. [ABSTRACT FROM AUTHOR]

The secret worlds of life experience, culture, sexuality and emotions are often expressed through physical “symptoms”. The lived body becomes the entry point for professionals to enter the world of the patient. This article, arising out of a study of the experiences of Greek women at menopause, discusses the story of one woman and interprets the cultural and emotional inscriptions that are carried into the clinical setting. It illustrates the multiple layers of corporeal meaning engendered by menopause and the clinical interactions surrounding it. It argues that the bodies that present themselves for consultation and examination are phenomenological memoirs of suffering, struggle and illness. Even in its most technical aspects medical practice cannot ignore the philosophies, values, goals and cultural experiences of those who seek its assistance. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the authors discuss various reports within the issue on topics including the role, nature, and status of truth in reconciliation discourses, creation of fecund practices based on vulnerability and loss, and reconciliatory discourse.

The article discusses concerns over the ethics of infectious diseases including the limits of the responsibility of heath care workers who are subjected to personal danger, the scope of restrictive measures for controlling outbreaks and the allocation of scarce resources. It cites the articles by Peter Omonzejele and Ross Upshur in the issue of "Journal of Bioethical Inquiry" which address the ebola virus disease (EVD) epidemic and exemplify the cultural dependence of ethical reflection.

The author comments on "The Dilemma of Revealing Sensitive Information on Paternity Status in Arabian Social and Cultural Contexts" by Abdallah A. Adlan and Henk A.M.J. ten Have. He discusses the three distinct discourses operating simultaneously, including science, medicine and bioethics; Islamic law that places value on the integrity of the family; and the tribal group. In his opinion, the article's inconsistency provoked concern due to the lack of rigorous, cohesive argument.

The article presents a case study of a 22-year-old Aboriginal man who was admitted to a hospital in northern Australia with a fracture of his right radius and ulna sustained in a motor car accident. It states that the patient remained agitated and trashed around when he awoke from the anaesthetic. It adds that the patient was admitted to the Intensive Care Unit for up to six weeks in view of his lack of understanding and agitated state.

The article presents a call for paper regarding a case study of a 22-year-old Aboriginal man who has Down Syndrome induced intellectual impairment and had met a motor accident resulting to fracture of his right arm.

The implementation of voluntary assisted dying (VAD) in the Australian State of Victoria in 2019 has stimulated discussions about end-of-life care and dying in many communities. Various attempts have been made to represent the attitudes of the Jewish community, a distinct culturally and linguistically diverse (CALD) group, in terms that suggest a unified set of opinions that opposes VAD policies. This research aimed to explore attitudes to VAD in the context of end-of-life care held by members of the Victorian Jewish community. A descriptive qualitative methodological design was employed. Ten Victorians who identify as Jewish were recruited and participated in in-depth, semi-structured interviews. Reflexive thematic analysis was carried out on the transcripts to identify key themes, attitudes and preferences in relation to end-of-life care, death and dying, and VAD. Three themes were identified: “complexity and variation”, “similarities”, and “factors influencing attitudes to VAD and end-of-life care”. A significant degree of diversity was apparent, ranging from highly supportive of VAD to advocacy for a total repeal of the policy. The results indicate that images of how Victorian Jewish individuals feel towards VAD based on essentialised notions about the community and belief systems are not supported by the evidence. In reality, considerable diversity of attitudes exists towards VAD and end-of-life care. We conclude that it is important that policymakers and members of the broader society avoid stereotypes that falsely characterise this specific community and, by implication, other CALD groups, particularly in terms that ignore internal diversity regarding belief systems, social attitudes and ethical perspectives. [ABSTRACT FROM AUTHOR]