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In 2014, the editorial board of BMC Medical Ethics came together to devise sections for the journal that would (a) give structure to the journal (b) help ensure that authors’ research is matched to the most appropriate editors and (c) help readers to find the research most relevant to them. The editorial board decided to take a practical approach to devising sections that dealt with the challenges of content management. After that, we started thinking more theoretically about how one could go about classifying the field of medical ethics. This editorial elaborates and reflects on the practical approach that we took at the journal, then considers an alternative theoretically derived approach, and reflects on the possibilities, challenges and value of classifying the field more broadly.

Research exploring parents’ experiences of having offspring with autism spectrum disorder (ASD) currently underrepresents fathers. This study aimed to develop an understanding of the experience of fathers, with a view to facilitating improved support. Eight fathers participated in semi-structured interviews exploring their experiences of fathering children with ASD. Fathers described their experiences as a path towards acceptance, with independence and integration for their offspring being key goals. Fathers saw themselves as advocates fighting obstructive services to access appropriate care. The value placed on formal and informal support varied, although the need for personalised support was emphasised. Enabling fathers to see their experiences as a journey, whilst engaging them on the important topics of independence and integration, may improve their experience.

IntroductionWorldwide, 10%–20% of children and adolescents experience mental health conditions. However, most such disorders remain undiagnosed until adolescence or adulthood. Little is known about the factors that influence mental health in children and adolescents, especially in low and middle-income countries (LMIC), where environmental threats, such as poverty and war, may affect optimal neurodevelopment. Cohort studies provide important information on risks and resilience across the life course by enabling tracking of the effects of early life environment on health during childhood and beyond. Large birth cohort studies, including twin cohorts that can be aetiologically informative, have been conducted within high-income countries but are not generalisable to LMIC. There are limited longitudinal birth cohort studies in LMIC.MethodsWe sought to enhance the volume of impactful research in Sri Lanka by establishing a Centre of Excellence for cohort studies. The aim is to establish a register of infant, child and adolescent twins, including mothers pregnant with twins, starting in the districts of Colombo (Western Province) and Vavuniya (Northern Province). We will gain consent from twins or parents for future research projects. This register will provide the platform to investigate the aetiology of mental illness and the impact of challenges to early brain development on future mental health. Using this register, we will be able to conduct research that will (1) expand existing research capacity on child and adolescent mental health and twin methods; (2) further consolidate existing partnerships and (3) establish new collaborations. The initiative is underpinned by three pillars: high-quality research, ethics, and patient and public involvement and engagement (PPIE).Ethics and disseminationEthical approval for this study was obtained from the Ethics Review Committee of Sri Lanka Medical Association and Keele University’s Ethical Review Panel. In addition to journal publications, a range of PPIE activities have been conducted.

There has been increasing debate in recent years about the conceptualization of moral distress. Broadly speaking, two groups of scholars have emerged: those who agree with Jameton’s ‘narrow definition’ that focuses on constraint and those who argue that Jameton’s definition is insufficient and needs to be broadened. Using feminist empirical bioethics, we interviewed critical care nurses in the United Kingdom about their experiences and conceptualizations of moral distress. We provide our broader definition of moral distress and examples of data that both challenge and support our conceptualization. We pre‐empt and overcome three key challenges that could be levelled at our account and argue that there are good reasons to adopt our broader definition of moral distress when exploring prevalence of, and management strategies for, moral distress.

BackgroundThe phenomenon of ‘moral distress’ has continued to be a popular topic for nursing research. However, much of the scholarship has lacked conceptual clarity, and there is debate about what it means to experience moral distress. Moral distress remains an obscure concept to many clinical nurses, especially those outside of North America, and there is a lack of empirical research regarding its impact on nurses in the United Kingdom and its relevance to clinical practice.Research aimTo explore the concept of moral distress in nursing both empirically and conceptually.MethodologyFeminist interpretive phenomenology was used to explore and analyse the experiences of critical care nurses at two acute care trauma hospitals in the United Kingdom. Empirical data were analysed using Van Manen’s six steps for data analysis.Ethical considerationsThe study was approved locally by the university ethics review committee and nationally by the Health Research Authority in the United Kingdom.FindingsThe empirical findings suggest that psychological distress can occur in response to a variety of moral events. The moral events identified as causing psychological distress in the participants’ narratives were moral tension, moral uncertainty, moral constraint, moral conflict and moral dilemmas.DiscussionWe suggest a new definition of moral distress which captures this broader range of moral events as legitimate causes of distress. We also suggest that moral distress can be sub-categroised according to the source of distress, for example, ‘moral-uncertainty distress’. We argue that this could aid in the development of interventions which attempt to address and mitigate moral distress.ConclusionThe empirical findings support the notion that narrow conceptions of moral distress fail to capture the real-life experiences of this group of critical care nurses. If these experiences resonate with other nurses and healthcare professionals, then it is likely that the definition needs to be broadened to recognise these experiences as ‘moral distress’.

Background There is growing interest in the use and incorporation of empirical data in bioethics research. Much of the recent focus has been on specific “empirical bioethics” methodologies, which attempt to integrate the empirical and the normative. Researchers in the field are, however, beginning to explore broader questions, including around acceptable standards of practice for undertaking such research. The framework: In this article, we further widen the focus to consider the overall shape of an empirical bioethics research project. We outline a framework that identifies three key phases of such research, which are conveyed via a landscaping metaphor of Mapping-Framing-Shaping. First, the researcher maps the field of study, typically by undertaking literature reviews. Second, the researcher frames particular areas of the field of study, exploring these in depth, usually via qualitative research. Finally, the researcher seeks to (re-)shape the terrain by issuing recommendations that draw on the findings from the preceding phases. To qualify as empirical bioethics research, the researcher will utilise a methodology that seeks to bridge these different elements in order to arrive at normative recommendations. We illustrate the framework by citing examples of diverse projects which broadly adopt the three-phase framework. Amongst the strengths of the framework are its flexibility, since (as the examples indicate) it does not prescribe any specific methods or particular bridging methodology. However, the framework might also have its limitations, not least because it appears particularly to capture projects that involve qualitative – as opposed to quantitative – research. Conclusions Despite its possible limitations, we offer the Mapping-Framing-Shaping framework in the hope that this will prove useful to those who are seeking to plan and undertake empirical bioethics research projects.

Jake Earl correctly identifies a range of ethical problems arising from medical innovation. The definition of innovation itself is, however, deeply problematic, contested, and contestable, and this is something we have grappled with in our own work on surgical innovation. This commentary explores what progress has been made in defining surgical innovation, considers the challenges that remain and how those challenges impact on Earl’s conclusions. It ends by considering a radical - though we think justifiable - departure from contemporary thinking by proposing the elimination of the term ‘innovation’.

Background This paper reports the process and outcome of a consensus finding project, which began with a meeting at the Brocher Foundation in May 2015. The project sought to generate and reach consensus on standards of practice for Empirical Bioethics research. The project involved 16 academics from 5 different European Countries, with a range of disciplinary backgrounds. Methods The consensus process used a modified Delphi approach. Results Consensus was reached on 15 standards of practice, organised into 6 domains of research practice (Aims, Questions, Integration, Conduct of Empirical Work, Conduct of Normative Work; Training & Expertise). Conclusions Through articulating these standards we outline a position that encourages responses, and through those responses we will be able to identify points of agreement and contestation that will drive the conversation forward. In that vein, we would encourage researchers, funders and journals to engage with what we have proposed, and respond to us, so that our community of practice of empirical bioethics research can develop and evolve further.

In this analysis we challenge the conceptual honesty of ‘shared decision making’, arguing that, although it is held up as an ideal decision-making standard, it is used too often to describe (and justify) decision-making practices that are not shared at all. This is problematic because, if the legitimacy of a decision relies on it being ‘shared’, but it is not in fact shared, the decision loses legitimacy, or is falsely legitimised by the appearance of being shared. We argue that the realities of clinical practice mean that genuinely shared decision making is not completely impossible but difficult to achieve in a sincere and just manner. We articulate an intentionally controversial stance, with the aim of generating thought and debate. Shared decision making has been offered as a way of better respecting patient autonomy, leading to management plans or actions that are in tune with patient values and therefore improving concordance. It provides a platform for respecting autonomy while avoiding abandoning patients to their autonomy, by giving them information without assistance in interpretation; this allows them to arrive at informed decisions that are in accord with their beliefs, values, and preferences. This ideal accords with the deliberative model of the clinician/patient relationship put forward by Emmanuel and Emmanuel being morally preferable to a paternalistic or informative/commercial relationship.1 In arguing that shared decision making is the pinnacle of patient-centred care, Barry and Edgman-Levitan describe it in the following terms: ‘… the clinician offers options and describes their risks and benefits, and the patient expresses his or her preferences and values. Each participant …

This chapter offers a reflection on some of the interconnected philosophical, ethical and methodological challenges that have arisen in the research on fatherhood and in response to scholarly engagements with fatherhood research. The case for research funding may be easier to make if the proposed research addresses a clear area of need and/or addresses issues in vulnerable populations. If there is resistance to fatherhood research, then, it is potentially influenced by the idea that fathers, as men, are already relatively advantaged, both socially and economically — and research that benefits an already advantaged group may be less important than research that benefits a more disadvantaged group. This depends, however, on who the putative beneficiaries of fatherhood research are.

'Conversations with Fathers' is a project at the University of Bristol aiming to create a space for the conversations about fatherhood that it might be difficult to have, as well as showcase and celebrate what is great about fatherhood.Matt, a father involved in the project, talked to us about his experience of depressive illness and how it affected him as a father and as a partner. This is an edited transcript of that conversation.

Aims: The aim of this narrative synthesis was to explore the necessary and sufficient conditions required to define moral distress. Background: Moral distress is said to occur when one has made a moral judgement but is unable to act upon it. However, problems with this narrow conception have led to multiple redefinitions in the empirical and conceptual literature. As a consequence, much of the research exploring moral distress has lacked conceptual clarity, complicating attempts to study the phenomenon. Design: Systematic literature review and narrative synthesis (November 2015–March 2016). Data sources: Ovid MEDLINE® In-Process & Other Non-Indexed Citations 1946–Present, PsycINFO® 1967–Present, CINAHL® Plus 1937–Present, EMBASE 1974–24 February 2016, British Nursing Index 1994–Present, Social Care Online, Social Policy and Practice Database (1890–Present), ERIC (EBSCO) 1966–Present and Education Abstracts. Review methods: Literature relating to moral distress was systematically retrieved and subjected to relevance assessment. Narrative synthesis was the overarching framework that guided quality assessment, data analysis and synthesis. Results: In all, 152 papers underwent initial data extraction and 34 were chosen for inclusion in the narrative synthesis based on both quality and relevance. Analysis revealed different proposed conditions for the occurrence of moral distress: moral judgement, psychological and physical effects, moral dilemmas, moral uncertainty, external and internal constraints and threats to moral integrity. Conclusion: We suggest the combination of (1) the experience of a moral event, (2) the experience of ‘psychological distress’ and (3) a direct causal relation between (1) and (2) together are necessary and sufficient conditions for moral distress.

Background:Withdrawal of treatment is a common practice in intensive care units when treatment is considered futile. Compassion is an important aspect of care; however, it has not been explored much within the context of treatment withdrawal in intensive care units.Objectives:The aim was to examine how concepts of compassion are framed, utilised and communicated by intensive care nurses in the context of treatment withdrawal.Design:The study employed a qualitative approach conducting secondary analysis of an original data set. In the primary study, 13 nurses were recruited from three intensive care units within a large hospital in United Kingdom. Deductive framework analysis was used to analyse the data in relation to compassionate care.Ethical considerations:The primary study was approved by the local Research Ethics Committee and the hospital’s Research and Development services.Findings:Compassionate care was mostly directed to the patient’s family and was demonstrated through care and emotional support to the family. It was predominantly expressed through attempts to maintain the patient’s dignity by controlling symptoms, maintaining patient cleanliness and removing technical apparatus.Conclusion:This study’s findings provide insight about compassionate care during treatment withdrawal which could help to understand and develop further clinicians’ roles. Prioritising the family over the patient raised concerns among nurses, who motivated by compassion, may feel justified in taking measures that are in the interests of the family rather than the patient. Further work is needed to explore the ethics of this.

In the UK, putative fathers are encouraged to be involved in antenatal and maternal health care, in the belief that involving men as early as possible lays the foundation for better, more involved fatherhood. Integrating men into maternity care can, however, have hitherto unexplored ethical complexities. We begin by providing three ethical justifications for involving men in antenatal and maternity health care, and then discuss how each necessarily constrains the nature of this involvement. The medical setting itself creates some of the difficulties. This observation leads us into a broader exploration of the medicalisation of men's transition to fatherhood.

Background: Depression following first episode psychosis (FEP) is a frequent occurrence, with profound impact on recovery and outcome. Whilst many theories exist about the causes of depression here, research to date has been based on nosology imported wholesale from affective disorder, with little primary research on the subjective experience. This study aimed to explore the subjective experience and phenomenological features of post-psychotic depression in FEP. Method: A qualitative methodology, photo-elicitation, together with unstructured interviews, was used to characterise aspects of depression following FEP and analysed using contemporary framework analysis. Results: Depression was reported by participants as linked to the experience of and recovery from psychosis. The psychotic episode was a traumatic event followed by subjective doubt, shame and embarrassment. Loss and social isolation were central. Core biological symptoms did not feature. Limitations: Despite the relatively small sample size, this study was able to generate in-depth data that provides useful and novel insight. Whilst generalisability is incompatible with qualitative methodology, further research using the same methodology would generate a wider range of experiences and perspectives. Conclusions: Understanding this dimension of psychosis in and of itself has the potential to improve and aid development of more effective and appropriately targeted interventions and associated outcomes.

Altruism has long been taken to be the guiding principle of ethical organ donation in the UK, and has been used as justification for rejecting or allowing certain types of donation. We argue that, despite this prominent role, altruism has been poorly defined in policy and position documents, and used confusingly and inconsistently. Looking at how the term has been used over recent years allows us to define ‘organ donation altruism’, and comparing this with accounts in the philosophical literature highlights its theoretical shortcomings. The recent report from the Nuffield Council on Bioethics reaffirmed the importance of altruism in organ donation, and offered a clearer definition. This definition is, however, more permissive than that of altruism previously seen in UK policy, and as a result allows some donations that previously have been considered unacceptable. We argue that while altruistic motivation may be desirable, it is not necessary.

In recent years there has been a wealth of literature arguing the need for empirical and interdisciplinary approaches to bioethics, based on the premise that an empirically informed ethical analysis is more grounded, contextually sensitive and therefore more relevant to clinical practice than an 'abstract' philosophical analysis. Bioethics has (arguably) always been an interdisciplinary field, and the rise of 'empirical' (bio)ethics need not be seen as an attempt to give a new name to the longstanding practice of interdisciplinary collaboration, but can perhaps best be understood as a substantive attempt to engage with the nature of that interdisciplinarity and to articulate the relationship between the many different disciplines (some of them empirical) that contribute to the field. It can also be described as an endeavour to explain how different disciplinary approaches can be integrated to effectively answer normative questions in bioethics, and fundamental to that endeavour is the need to think about how a robust methodology can be articulated that successfully marries apparently divergent epistemological and metaethical perspectives with method. This paper proposes 'Reflexive Bioethics' (RB) as a methodology for interdisciplinary and empirical bioethics, which utilizes a method of 'Reflexive Balancing' (RBL). RBL has been developed in response to criticisms of various forms of reflective equilibrium, and is built upon a pragmatic characterization of Bioethics and a 'quasi-moral foundationalism', which allows RBL to avoid some of the difficulties associated with RE and yet retain the flexible egalitarianism that makes it intuitively appealing to many.

Teaching and learning practice in higher education (HE) should incorporate educational evaluation, both for the purpose of external and internal quality assurance and to monitor and improve the student experience. Methods used to evaluate education vary, but the majority of literature on course evaluation is based on quantitative surveys of the learner experience. One alternative to survey evaluation is 'nominal group technique' (NGT), which has been used with some success in curriculum development. This multi-method study aimed to (1) compare the nature and quality of data gathered using NGT with standard written questionnaires, (2) assess the usefulness of the feedback for an individual teacher and institution and (3) consider the appropriateness and feasibility of widespread use. Both the standard written questionnaire and NGT generated data on similar topics. The structured nature of the questionnaire tended to generate short answers which were similar to the results of the NGT ranking exercise. However, in contrast to the questionnaire data, the NGT discussion phase allowed in-depth exploration and interrogation of students' views. Whilst the specific data gathered via NGT are unlikely to be useful for quality assurance purposes within an institution, since they is not easily comparable, they can provide teachers with in-depth information on how to improve the learning experience and improve the efficacy of teaching. It is likely that NGT evaluation will be particularly useful when evaluating new courses, identifying problems in poorly performing courses, and identifying good practice in high-performing courses. Institutional investment in selective NGT evaluation may be more feasible than routine use.

Bioethics is a diverse field that accommodates a broad range of perspectives and disciplines. The recent explosion of literature on methods in interdisciplinary and empirical ethics might appear, however, to overshadow the fact that ‘bioethics’ has long been an interdisciplinary field. The Interdisciplinary and Empirical Ethics Network (IEEN) was established, with funding from the Wellcome Trust, to facilitate critical and constructive discussion around the nature of this disciplinary diversity and shift focus away from the ‘empirical turn’, towards the ongoing development of bioethics as an evolving field of interdisciplinary study. In April 2012 the IEEN organized a workshop at the Centre for Public Policy Research, King's College London, dedicated to discussing the relationship between aims and methods in interdisciplinary and empirical bioethics. This paper reports on that first meeting.

Bioethics has long been accepted as an interdisciplinary field. The recent 'empirical turn' in bioethics is however, creating challenges that move beyond those of simple interdisciplinary collaboration, as researchers grapple with the methodological, empirical and meta-ethical challenges of combining the normative and the empirical, as well as navigating the difficulties that can arise from attempts to transcend traditional disciplinary boundaries. Empirical Bioethics: Practical and Theoretical Perspectives brings together contributions from leading experts in the field which speak to these challenges; providing insight into how they can be understood and suggestions for how they might be overcome. Combining discussions of meta-ethical challenges, examples of different methodologies for integrating empirical and normative research, and reflection on the challenges of conducting and publishing such work, this book will both introduce the novice to the field and challenge the expert.

BACKGROUND: Despite the increased prevalence of bioethics research that seeks to use empirical data to answer normative research questions, there is no consensus as to what an appropriate methodology for this would be. This review aims to search the literature, present and critically discuss published Empirical Bioethics methodologies.METHODS: MedLine, Web of Science and Google Scholar were searched between 15/02/12 and 16/06/13 to find relevant papers. These were abstract reviewed independently by two reviewers with papers meeting the inclusion criteria subjected to data extraction.RESULTS: 33 publications (32 papers and one book chapter) were included which contained 32 distinct methodologies. The majority of these methodologies (n = 22) can be classed as either dialogical or consultative, and these represent two extreme 'poles' of methodological orientation. Consideration of these results provoked three central questions that are central to the planning of an empirical bioethics study, and revolve around how a normative conclusion can be justified, the analytic process through which that conclusion is reached, and the kind of conclusion that is sought.CONCLUSION: When considering which methodology or research methods to adopt in any particular study, researchers need to think carefully about the nature of the claims they wish to generate through their analyses, and how these claims align with the aims of the research. Whilst there are superficial similarities in the ways that identical research methods are made use of, the different meta-ethical and epistemological commitments that undergird the range of methodological approaches adopted rehearse many of the central foundational disagreements that play out within moral philosophy and bioethical analysis more broadly. There is little common ground that transcends these disagreements, and we argue that this is likely to present a challenge for the legitimacy of the bioethical enterprise. We conclude, however, that this heterogeneity ought to be welcomed, but urge those involved in the field to engage meaningfully and explicitly with questions concerning what kinds of moral claim they want to be able to make, about normative justification and the methodological process, and about the coherence of these components within their work.

In a thought-provoking target article, Kon (2009) seeks to answer the question of how empirical data might inform normative bioethics by organizing four categories of research into a hierarchy, def...

Over the last decade, patient and public involvement (PPI) has become a requisite in applied health research. Some funding bodies demand explicit evidence of PPI, while others have made a commitment to developing PPI in the projects they fund. Despite being commonplace, there remains a dearth of engagement with the ethical and theoretical underpinnings of PPI processes and practices. More specifically, while there is a small (but growing) body of literature examining the effectiveness and impact of PPI, there has been relatively little reflection on whether the concept/practice of PPI is internally coherent. Here, the authors unpick a 'paradox' within PPI, which highlights a tension between its moral and pragmatic motivations and its implementation. The authors argue that this 'professionalisation paradox' means we need to rethink the practice, and purpose, of PPI in research.

In this paper we set forth what we believe to be a relatively controversial argument, claiming that ‘bioethics’ needs to undergo a fundamental change in the way it is practised. This change, we argue, requires philosophical bioethicists to adopt reflexive practices when applying their analyses in public forums, acknowledging openly that bioethics is an embedded socio-cultural practice, shaped by the ever-changing intuitions of individual philosophers, which cannot be viewed as a detached intellectual endeavour. This said, we argue that in order to manage the personal, social and cultural embeddedness of bioethics, philosophical bioethicists should openly acknowledge how their practices are constructed and should, in their writing, explicitly deal with issues of bias and conflict of interest, just as empirical scientists are required to do.

Healthcare workers (HCWs) are often assumed to have a duty to work, even if faced with personal risk. This is particularly so for professionals (doctors and nurses). However, the health service also depends on non-professionals, such as porters, cooks and cleaners. The duty to work is currently under scrutiny because of the ongoing challenge of responding to pandemic influenza, where an effective response depends on most uninfected HCWs continuing to work, despite personal risk. This paper reports findings of a survey of HCWs (n = 1032) conducted across three National Health Service trusts in the West Midlands, UK, to establish whether HCWs' likelihood of working during a pandemic is associated with views about the duty to work. The sense that HCWs felt that they had a duty to work despite personal risk emerged strongly regardless of professional status. Besides a strong sense that everyone should pull together, all kinds of HCWs recognised a duty to work even in difficult circumstances, which correlated strongly with their stated likelihood of working. This suggests that HCWs' decisions about whether or not they are prepared to work during a pandemic are closely linked to their sense of duty. However, respondents' sense of the duty to work may conflict with their sense of duty to family, as well as other factors such as a perceived lack of reciprocity from their employers. Interestingly, nearly 25% of doctors did not consider that they had a duty to work where doing so would pose risks to themselves or their families.

In this paper we argue that there are few morally acceptable justifications for a man to seek a paternity test. The relationship between material responsibility and the burdens generated by the creation of a needy child, means it is not unreasonable for a man to establish that he is responsible for the creation of a child before accepting this financial responsibility. Some men embrace fatherhood irrespective of their involvement in the children's creation and in the absence of a genetic relationship. Others feel differently. Given that parenting is a life-long commitment it is reasonable for those for whom genetics matters to request a paternity test prior to making this commitment. Once a man has become a (moral) father there is no justification for initiating paternity testing, save in the interests of the child. Where the child's interest in knowing his/her genetic origins is unclear we argue this is a decision that can be left for the child to make for him/herself when he/she is sufficiently mature. ...

In the third of a series of articles examining ethical issues in primary care research, we argue that family doctors, when considering what they ought to do in relation to research, have a positive obligation to participate in research and that one means of discharging this obligation is to collaborate in research studies by aiding recruitment. We offer three arguments in support of this obligation-arguments from fairness, reason and utility. We then go on to specify a series of conditions on this obligation which take into account that doctors have many other obligations. These are the conditions of financial remuneration, reciprocity and ability.

Sometimes researchers fail to meet their recruitment targets, and sometimes it is predicted that recruitment may prove difficult but it is not obvious what ethical latitude researchers have to boost participation by, for instance, paying participants to take part or by paying family doctors to recruit patients to participate. In this paper, we distinguish between payment, reimbursement and inducement. We look first at the ethics of paying research participants. We conclude that payment raises all kinds of ethical difficulties, but that reimbursement-whilst not completely unproblematic-is an ethical requirement. We then look at whether some inducement to participate is acceptable and conclude that it is. We continue by asking whether the same arguments can be applied to encouraging family doctors to recruit patients. We conclude that it is right for family doctors to be reimbursed for the costs of recruiting research participants and also argue that there are fewer problems with paying family doctors to recruit patients than there are with paying research participants. Given, however, that there is a fine line between reimbursement and payment, given the potential for conflicts of interests to arise, and given that even suspicion of such a conflict might undermine trust in doctors, systems of both payment and reimbursement need to be transparent.

The rise of a ‘new’ empirical bioethics, which aims to ground normative judgments in ‘real-world’ data relating to different ethical problems in the biomedical sciences, has been well-documented in recent years. – 7 Indeed, the journal Clinical Ethics was established as a valuable forum for the dissemination of research that embraced an empirical approach to the exploration of ethical problems in clinical practice. For postgraduates who see themselves as engaging in bioethics research, these developments present both a real opportunity to adopt a broad range of disciplinary perspectives in exploring their chosen topic, and a series of challenges in producing rigorous and respected work that might lead to an established academic career. The breadth of the field called ‘bioethics’ is well-suited to postgraduate research. At this level, researchers have a great degree of freedom to draw on different theoretical and methodological traditions in developing projects that address new problems in different ways. Indeed, one might say that this freedom to explore and experiment with different perspectives is what makes undertaking a PhD so special. However, this process of experimentation is also conducive to producing identity crises. When asked to describe the work that we do, we might respond by saying, for example, that it has a social scientific, a philosophical, a legal and a psychiatric component. When asked how these components integrate, or when called to account on the basis of the quality of our research by supervisors, reviewers or examiners, we have an uneasy sense that everything might unravel around us, our projects amounting to less than the sum of their parts.

In this paper, we present the first stage of an empirical bioethics project exploring the moral sources of paternal responsibilities and rights. In doing so, we present both (1) data on men's normative constructions of fatherhood and (2) the first of a two-stage methodological approach to empirical bioethics. Using data gathered from 12 focus groups run with UK men who have had a variety of different fathering experiences ( n = 50), we examine men's perspectives on how paternal responsibilities and rights are generated and the significance of the genetic connection within the father–child relationship. We do not attempt to explore men's experiences of fatherhood or their fathering practices; and neither is the analysis driven from a particular sociological perspective. Rather, we explore men's normative constructions of fatherhood in order to present accessible data that might be of significance to the philosophical/moral debate on the sources of paternal rights and responsibilities.

In our seventh and final piece on the theme “Good without God”, Jonathan Ives argues that reliance on God as an external source of moral authority leads to a kind of moral cowardice.

‘Bioethics: past, present and future’ was a conference whose purpose was to create a snapshot of postgraduate work in bioethics. This work, it was hoped, would be illustrative of the new generation of academics working in the field, and of their attitudes towards their discipline. The conference attracted postgraduates from diverse areas and backgrounds, unified by their shared work in bioethics. Given such a disparate group one might have thought there would be a great deal of disagreement about what bioethics is and what counts as ‘doing bioethics’, yet this was not the case. There were variations of interpretation as to what constitutes bioethics, but the points on which there was agreement were far more striking. Throughout the 2 days of the conference, during formal presentations and informal

Objective Auditory verbal hallucinations (AVHs) are core features of psychotic illness and remain significant in predicting poor outcome and risk. There has been a wide range of approaches to understanding these experiences. Method A systematic literature review summarizing different methods of investigation and their results; phenomenology, descriptive psychopathology, psychological, cognitive neurobiology, and neuroimaging. Results A number of 764 papers and texts were screened and 113 reviewed. Phenomenological studies are comparably few in number, and psychopathology remains based on concepts defined in the early 20th century. Psychological models focus on voice content and emotional reaction, and suggest a continuum of AVHs from normal experience. Neuropsychological models include AVHs as misattribution of inner speech, whilst functional neuroimaging studies focus on the spontaneous activity and connectivity of auditory networks. Conclusion There has been a large growth in research on AVHs in recent decades dominated by neurobiological and neuroimaging studies. Future research should include focus on phenomenological aspects and AVHs change over the course of developing illness. Integration between branches of enquiry is needed, and the risk is that without this, models are proposed and investigated that bear scant relevance to the symptom itself.

Background In dimensional understanding of psychosis, auditory verbal hallucinations (AVH) are unitary phenomena present on a continuum from non-clinical voice hearing to severe mental illness. There is mixed evidence for this approach and a relative absence of research into subjective experience of AVH in early psychosis. Aims To conduct primary research into the nature of subjective experience of AVH in first-episode psychosis. Method A phenomenological study using diary and photo-elicitation qualitative techniques investigating the subjective experience of AVH in 25 young people with first-episode psychosis. Results AVH are characterised by: (a) entity, as though from a living being with complex social interchange; and (b) control, exerting authority with ability to influence. AVH are also received with passivity, often accompanied by sensation in other modalities. Conclusions A modern detailed phenomenological investigation, without presupposition, gives results that echo known descriptive psychopathology. However, novel findings also emerge that may be features of AVH in psychosis not currently captured with standardised measures. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Bioethics is an interdisciplinary field that accommodates a broad range of perspectives and disciplines. This inherent diversity sets a number of challenges for both teachers and students of bioethics, notably in respect to the appropriate aims and methods of bioethics education, standards and criteria for evaluating performance and disciplinary identity. The Interdisciplinary and Empirical Ethics Network (IEEN) was established, with funding from the Wellcome Trust, to facilitate critical and constructive discussion about the ongoing development of bioethics as an evolving field of interdisciplinary study. In November 2012 the IEEN organised a workshop at the University of Birmingham to discuss the issues relating to teaching and learning in interdisciplinary and empirical bioethics. This paper reports on that meeting.

The Interdisciplinary and Empirical Ethics Network was established in 2012 with funding from the Wellcome Trust in order to facilitate critical and constructive discussion around the nature of the disciplinary diversity within bioethics and to consider the ongoing development of bioethics as an evolving field of interdisciplinary study. In April 2013, the Interdisciplinary and Empirical Ethics Network organized a workshop at the Centre for Public Policy Research, King’s College London, which discussed the nature and possibility of professionalism within interdisciplinary and empirical bioethics. This paper provides a report of that workshop.

This paper argues that the convention of allocating donated gametes on a “first come, first served” basis should be replaced with an allocation sys-tem that takes into account more morally relevant criteria than waiting time. This conclusion was developed using an empirical bioethics method-ology, which involved a study of the views of eighteen staff members from seven UK fertility clinics, and twenty academics, policy-makers, representa-tives of patient groups, and other relevant professionals, on the allocation of donated sperm and eggs. Against these views, we consider some nu-anced ways of including criteria in a points allocation system. We argue that such a system is more ethically robust than “first come, first served”, but we acknowledge that our results suggest that a points system will meet with resistance from those working in the field. We conclude that criteria such as a patient’s age, potentially damaging substance use, and parental status should be used to allocate points and determine which patients re-ceive treatment and in what order. These and other factors should be ap-plied according to how they bear on considerations like child welfare, pa-tient welfare, and the effectiveness of the proposed treatment.

In "A Conceptual Model for the Translation of Bioethics Research and Scholarship," Debra Mathews et al. aim to "begin an important discussion" about how to measure success in bioethics, and in doing so they set out a typology of bioethics research and scholarship with the arguably correct assumption that we cannot evaluate success in bioethics without first understanding what its goals are. I think the authors are correct in their claim that, in the current academic climate, having work in bioethics deemed a success is likely to hinge, in some way, on its being translated into practice and having impact. I want, however, to add a critical voice in the form of three considerations that I feel ought to be attended to before the work progresses further, the first being that the typology Mathews et al. propose is highly problematic. Although there is a burgeoning literature on "empirical bioethics" methodologies that blend empirical and conceptual work, the typology appears to ignore this.