Search

Stem cells are increasingly being used to model human development and disease in the form of self-organizing embryo models, brain organoids, and neurological chimeras. These new research directions are resurrecting old embryo debates around moral status and personhood. Hyun considers how these old questions are tackled in these new contexts.

Medical ethics would be better if people were taught to think more clearly about well-being or (what I take to be the same thing) the concept of what is good for a person. Yet for a variety of reasons, bioethicists have generally paid little attention to this concept. Here, I argue, first, that focusing on general theories of welfare is not useful for practical medical ethics. I argue, second, for what I call the “theory-without-theories approach” to welfare in practical contexts. The first element of this approach is a focus on examining important and relatively uncontroversial constituents of welfare as opposed to general theories. The second key element is a framework for thinking about choice in relation to welfare, a framework I refer to as “the mild objectivity framework.” I conclude with illustrations of the way in which the “theory without theories approach” can improve thinking in medicine.

Prolife theorists typically hold to the claim that all human beings possess equal moral status from conception and consequently possess a right to life. This, they believe, entails that abortion is impermissible in all circumstances. Critics characterize this as an extreme anti-abortion position, as it prima facie allows no exceptions, even in cases of rape. Here, I examine whether the prolife claim regarding equal moral status is compatible with a more attractive moderate stance that permits an exception in the case of rape. I show that Judith Jarvis Thomson's analysis of rights can be used to modify the prolife position in this way, but that doing so involves concessions that prolife theorists are unlikely to find acceptable.

Purpose To explore and compare the perceptions of nurses and parent/family advisors regarding pediatric nurses' moral obligations to children and families during an active shooter event in a children's hospital. Design and methods This was a descriptive, exploratory study using survey methodology. A convenience sample of all licensed nurses and parent/family advisors from four children's hospitals across the United States were recruited. Surveys consisted of five primary domains including Appropriateness of National Guidelines, Personal Preparedness, Moral Accountability, Professional/Legal Concerns, and Personal Risk Expectations. Frequency counts and percentages were calculated for each survey item. Results Data from 874 pediatric nurses and 81 parent/family advisors were analyzed. Most respondents believed the Run-Hide-Fight campaign should be changed to Secure-Preserve-Fight. Only 30% of nurses felt mentally prepared to respond to an active shooter event. Most respondents agreed that nurses have a professional duty to protect their patients, but agreed that it was a personal choice, not a moral obligation, to accept potentially fatal risks. Hospital setting and patient vulnerability often influenced nurses' perceived obligations to patients. Most respondents reported they would not leave their patient/child during an active shooter event. Conclusions Nurses feel morally obligated to patients, but must balance their own personal risk tolerance level against the need to protect patients and families. Practice implications Hospitals need in-depth active shooter training for both nurses and parents as well as safety plans that address both evacuation protocols and measures to secure in place to protect the lives of patients, families, and staff.

This article examines Kant's overlooked concept of "active play," as opposed to "free play," in connection with the influence of the Brunonian system of medicine, both of which, I propose, are central to understanding the broader significance of intoxication in Kant's post-1795 work. Beginning with a discussion of the late-18th century German reception of Brunonian theory, the idea of vital stimulus, and their importance for Kant, I assess the distinction drawn between gluttony and intoxication in The Metaphysics of Morals and Anthropology from a Practical Point of View. Both are analysed in the context of the Brunonian system of medicine, having establishing Kant's commitment to the Brunonianism system, as corroborated by Wasianski. What emerges is a novel understanding of intoxication in the work of Immanuel Kant, which brings to light a previously unexamined dynamic between imagination, intoxication, and the aesthetic.

It has been argued that Thomson's defense of abortion, if successful, implies that abortion is permissible only until the point of viability. After that point, if one wanted to end a pregnancy, one must do so by birthing the fetus through induction or cesarean. In this paper, I argue that Thomson's defense of abortion does, in fact, imply that abortion after the point of viability is sometimes permissible. To show this, I point out that the process of birthing a fetus makes use of the body of the pregnant person in significant ways. Indeed, the body of the pregnant person is as much a part of this process as it is a part of the process of carrying a fetus during pregnancy. Thus, just as it is sometimes morally permissible to choose to have an abortion rather than continue a pregnancy, it is sometimes morally permissible to choose to have an abortion rather than undergo an induction or cesarean. Those who support Thomson's defense of abortion, then, have reason not to support the view that induction or cesarean are the only permissible procedures for ending an unwanted pregnancy with a viable fetus. I then use this discussion to suggest that autonomy rights are more complicated than initially thought. Given the extent to which the body is involved in detaching the fetus, it is not merely that one has a right to detach a fetus, but also a right to actualize one's reasonable preferences over the method of detachment.

Contains fulltext : 287766.pdf (Publisher’s version ) (Open Access) A self-fulfilling prophecy (SFP) in neuroprognostication occurs when a patient in coma is predicted to have a poor outcome, and life-sustaining treatment is withdrawn on the basis of that prediction, thus directly bringing about a poor outcome (viz. death) for that patient. In contrast to the predominant emphasis in the bioethics literature, we look beyond the moral issues raised by the possibility that an erroneous prediction might lead to the death of a patient who otherwise would have lived. Instead, we focus on the problematic epistemic consequences of neuroprognostic SFPs in settings where research and practice intersect. When this sort of SFP occurs, the problem is that physicians and researchers are never in a position to notice whether their original prognosis was correct or incorrect, since the patient dies anyway. Thus, SFPs keep us from discerning false positives from true positives, inhibiting proper assessment of novel prognostic tests. This epistemic problem of SFPs thus impedes learning, but ethical obligations of patient care make it difficult to avoid SFPs. We then show how the impediment to catching false positive indicators of poor outcome distorts research on novel techniques for neuroprognostication, allowing biases to persist in prognostic tests. We finally highlight a particular risk that a precautionary bias towards early withdrawal of life-sustaining treatment may be amplified. We conclude with guidelines about how researchers can mitigate the epistemic problems of SFPs, to achieve more responsible innovation of neuroprognostication for patients in coma.

Ethical frameworks can support professionals' decision-making. Here, we identify two ethical frameworks to analyse the best support for families that struggle with parental substance or alcohol abuse. The first framework, which we call 'the framework of conflicting interests', is most prominent in the literature. Here, the interests of parents and children are weighed against each other using the medical ethical principles of respect for autonomy, justice, beneficence, and non-maleficence. The second framework is most prominent in a series of interviews we conducted with alcohol-dependent parents and professionals working in addiction care and youth care. This framework aligns more with an ethics of care, and starts with the assumption that the interests of people who are close to each other are often intertwined. This framework does not so much look at conflicting interests, but at relationships and vulnerability. We label this the ethics of care framework. In this article, we show the value of both frameworks and how they can support ethical decision-making.

Most opposition to induced abortion turns on the belief that human fetuses are persons from conception. On this view, the moral status of the fetus alone requires those in a position to provide aid—gestational mothers—to make tremendous sacrifices to benefit the fetus. Recently, critics have argued that this pro-life position requires more than opposition to induced abortion. Pro-life theorists are relatively silent on the issues of spontaneous abortion, surplus in vitro fertilisation human embryos, and the suffering and death of born persons due to lack of access to food, shelter and medical care. Colgrove et al call such arguments inconsistency arguments, arguing they ‘do not matter’ and mischaracterise them as ad hominem attacks. Here, I argue these are better understood as moral dilemmas. While some critics argue pro-life inaction is evidence that they do not really believe human fetuses are persons, I contend this inaction is likely the result of resolvable confusion rather than moral negligence.

Judith Jarvis Thomson famously argued that abortion is permissible even if we accept that a fetus qualifies as a person and possesses a right to life. The current paper presents two arguments that undermine Thomson’s position. First, the paper sketches a contractarian argument that explores Thomson’s violinist thought experiment from behind a veil of ignorance, which suggests that if we had an equal likelihood of being an unwanted fetus and a pregnant woman, it would be rational for us to oppose abortion. Second, the paper discusses the hypothetical self-aborting fetus, a thought experiment that reverses the dependence relationship between a woman and a fetus. It is argued that in this scenario, where fetuses have agency of their own, Thomson’s position would counterintuitively prohibit a woman from temporarily curtailing the freedom of her fetus even to save her own life.

This article examines the current BHIVA/BASHH guidelines on the disclosure of HIV+ status in the context of sexual activity. It assesses whether the guidance provided on how to avoid criminal prosecution accurately reflects the prevailing position in law. Given that aspects of the guidance related to non-disclosure of HIV infection in the context of low or negligible risk are as yet untested in UK law, it is argued that there is some uncertainty as to whether the professional body guidelines and the law can be reconciled with each other. The article also considers whether the BHIVA/BASHH guidelines stray beyond the boundaries of medical advice as normally understood (focused on the protection of health and the prevention of onward transmission), by posing both as legal advice on how to avoid prosecution and offering what could be viewed as a moral judgement as to when disclosure is required. While a bio-medical assessment of risk naturally shapes clinical guidelines and may also inform views as to appropriate sexual behaviour and risk-taking, it is unclear whether scientific assessment of risk should be the sole guide when it comes to determining the nature of any disclosure obligation or the medical advice to be given on this matter.

Pro-life advocates commonly argue that fetuses have the moral status of persons, and an accompanying right to life, a view most pro-choice advocates deny. A difficulty for this pro-life position has been Judith Jarvis Thomson's violinist analogy, in which she argues that even if the fetus is a person, abortion is often permissible because a pregnant woman is not obliged to continue to offer her body as life support. Here, we outline the moral theories underlying public health ethics, and examine the COVID-19 pandemic as an example of public health considerations overriding individual rights. We argue that if fetuses are regarded as persons, then abortion is of such prevalence in society that it also constitutes a significant public health crisis. We show that on public health considerations, we are justified in overriding individual rights to bodily autonomy by prohibiting abortion. We conclude that in a society that values public health, abortion can only be tolerated if fetuses are not regarded as persons.

Assisted reproductive technologies have greatly increased our control over reproductive choices, leading some bioethicists to argue that we face unprecedented moral obligations towards progeny. Several models attempting to balance the principle of procreative autonomy with these obligations have been proposed. The least demanding is the minimal threshold model (MTM), according to which every reproductive choice is permissible, except creating children whose lives will not be worth living. Hence, as long as the future child is likely to have a life worth living, prospective parents may be allowed to use preimplantation genetic diagnosis (PGD) to select embryos with genetic diseases or disabilities. Assuming a consequentialist person‐affecting view of morality, this paper investigates whether the MTM is an appropriate tool to guide procreative decisions given the continuous development of reproductive genetic technologies. In particular, I consider germline genome editing (GGE) and I argue that its application in human reproduction, unlike PGD, should be conceived as person‐affecting towards future progeny. I claim that even if we assume the plausibility of the MTM within PGD, we are committed to accepting that a greater moral obligation towards progeny should guide procreative decisions if GGE were available. In this case, the MTM should no longer be considered an appropriate instrument to guide procreative choices. Finally, I investigate when we face this greater moral obligation, concluding that it applies only when prospective parents have already engaged in the in vitro fertilization process.

This paper deals with the proposal of a person-affecting version of the principle of Procreative Beneficence. Such a principle has been stated by Savulescu & Kahane in an impersonal form and balanced with a person-affecting principle of harm to address the moral problem of the selection of future children. The paper aims to show some differences between Person-affecting Procreative Beneficence and Savulescu & Kahane's hybrid position, and to distinguish the former from other pro-selection perspectives. Moreover, it explores the extension of such a principle beyond selection to other issues of reproductive ethics.

Background Under COVID-19 pandemic, many organizations developed guidelines to deal with the ethical aspects of resources allocation. This study describes the results of an argument-based review of ethical guidelines developed at the European level. It aims to increase knowledge and awareness about the moral relevance of the outbreak, especially as regards the balance of equity and dignity in clinical practice and patient’s care. Method According to the argument-based review framework, we started our research from the following two questions: what are the ethical principles adopted by the ethical guidelines produced at the beginning of the COVID-19 outbreak related to resource allocation? And what are the practical consequences in terms of 'priority' of access, access criteria, management of the decision-making process and patient care? Results Twenty-two ethical guidelines met our inclusion criteria and the results of our analysis are organized into 4 ethical concepts and related arguments: the equity principle and emerging ethical theories; triage criteria; respecting patient’s dignity, and decision making and quality of care. Conclusion Further studies can investigate the practical consequences of the application of the guidelines described, in terms of quality of care and health care professionals’ moral distress.

What counts as discrimination? Sometimes an event has to be a deliberate act of hate before it is described as discrimination. Sometimes “discrimination” can include much more subtle actions (e.g., microaggressions). There is good evidence that “what counts” as discrimination is mired in controversy, uncertainty, or ambivalence. We present a novel approach that bridges sociocultural and social cognitive accounts of “discrimination.” Definitional boundaries of discrimination are the widely shared, common sense rules that people deploy when arguing whether an event constitutes discrimination or not (e.g., an emphasis on the personality of the alleged perpetrator; the importance of intention; and claims that the problem of discrimination is small and/or mostly limited to the past). These rules are culturally situated but also deployed by individuals in specific local contexts. We introduce a 15‐item measure of the extent to which participants are deploying broader or narrower definitional boundaries of discrimination (DBDs). We demonstrate that the measure has good convergent and discriminant validity (Study 1); that participants who are deploying narrow DBDs are less likely to make attributions to discrimination (Study 2); that participants' DBDs predict judgments for some intergroup contexts but not others (Study 3), and that participants who identify as racialized majorities have significantly narrower racism DBDs compared to participants who identify as racialized minorities (Study 4). We conclude with suggestions about how DBDs could be used in future research.

Some people oppose abortion on the grounds that fetuses have full moral status and thus a right to not be killed. We argue that special obligations that hold between mother and fetus also hold between parents and their children. We argue that if these special obligations necessitate the sacrifice of bodily autonomy in the case of abortion, then they also necessitate the sacrifice of bodily autonomy in the case of organ donation. If we accept the argument that it is obligatory to override a woman’s bodily autonomy for the sake of an unborn child’s survival, we must continue to override the bodily autonomy of parents to ensure the survival of their living children, until the parent no longer has a special obligation to their child to the same degree as their special obligation to the fetus. And if the life of a child is truly more important than the bodily autonomy of its parents, as must be the case to force women to carry unwanted pregnancies to term, this should remain true until such a time that their children are no longer considered their responsibility. Thus, parity of reasoning suggests that policies compelling the gestation of a fetus should be accompanied by policies compelling organ donation.

BackgroundThe coronavirus 2019 pandemic placed unprecedented pressures on healthcare services and magnified ethical dilemmas related to how resources should be allocated. These resources include, among others, personal protective equipment, personnel, life-saving equipment, and vaccines. Decision-makers have therefore sought ethical decision-making tools so that resources are distributed both swiftly and equitably. To support the development of such a decision-making tool, a systematic review of the literature on relevant ethical values and principles was undertaken. The aim of this review was to identify ethical values and principles in the literature which relate to the equitable allocation of resources in response to an acute public health threat, such as a pandemic.MethodsA rapid systematic review was conducted using MEDLINE, EMBASE, Google Scholar, LitCOVID and relevant reference lists. The time period of the search was January 2000 to 6th April 2020, and the search was restricted to human studies. January 2000 was selected as a start date as the aim was to capture ethical values and principles within acute public health threat situations. No restrictions were made with regard to language. Ethical values and principles were extracted and examined thematically.ResultsA total of 1,618 articles were identified. After screening and application of eligibility criteria, 169 papers were included in the thematic synthesis. The most commonly mentioned ethical values and principles were: Equity, reciprocity, transparency, justice, duty to care, liberty, utility, stewardship, trust and proportionality. In some cases, ethical principles were conflicting, for example, Protection of the Public from Harm and Liberty.ConclusionsAllocation of resources in response to acute public health threats is challenging and must be simultaneously guided by many ethical principles and values. Ethical decision-making strategies and the prioritisation of different principles and values needs to be discussed with the public in order to prepare for future public health threats. An evidence-based tool to guide decision-makers in making difficult decisions is required. The equitable allocation of resources in response to an acute public health threat is challenging, and many ethical principles may be applied simultaneously. An evidence-based tool to support difficult decisions would be helpful to guide decision-makers.

Preclinical advances in life-sustaining porcine cardiac xenotransplantation from donor pigs to baboons have paved the way for the performance of porcine cardiac xenotransplantation in a human. This procedure was performed with emergency use authorisation granted by the United States Food and Drug Administration under the umbrella of investigational new drug use on compassionate grounds. The patient was denied candidacy for durable mechanical circulatory support and heart transplantation as a result of non-adherence to medical advice. Successful porcine cardiac xenotransplantation in humans will significantly increase the availability of potential donor organs for long-term management of end-stage heart failure. Human porcine cardiac xenotransplantation is associated with ethical conflicts encompassing multiple ethical principles which are not mutually exclusive and are sometimes conflicting. This article focuses on some of the ethical conflicts encountered in relation to the use of mechanical circulatory support, pretransplant evaluation, shared decision making during informed consent, infectious disease risk, preclinical and clinical testing, and the role of regulatory bodies during performance of the first human porcine cardiac xenotransplantation. An increase in human trials of xenotransplantation procedures is imminent. Potential ethical conflicts associated with xenotransplantation should be addressed appropriately.

Human rights violations in armed conflict against community members, displaced persons, and health workers include combatants' uses of threats and coercion, attacks on health facilities, and abuses against civilians. Traditional clinical and public health ethical obligations are not sufficient to guide practice in those spaces. This article describes some of the complex realities of health practice in conflict zones that challenge adherence to clinicians' ethical obligations and create severe risks to the health, well-being, and dignity of the people they serve. It also proposes some solutions to these challenges.

The World Health Organization (WHO) in its Alma Ata Declaration, 1978, focuses on the development, promotion and recognition of the traditional medical systems. India has taken steps in this direction by recognising Unani medicine with other traditional medical systems practised in India. Presently, Government is promoting integration of the recognised traditional medical systems with conventional medicine at the national level, as an interdisciplinary approach to providing better patient-centred care. Bioethics is a field of enquiry that examines ethical issues and dilemmas emerging from medical care and research involving humans. Although the term ‘bioethics’ was first mentioned in 1927 and later established as a distinct discipline in 1970s, the ethical principles in various contexts had been described centuries ago in the classical texts pertaining to traditional medical systems. Since ethics as a code of conduct was followed by ancient Unani physicians to safeguard the interests of humanity when providing healthcare, it was felt that a review of classical Unani manuscripts should be attempted to give an insight into codes of conduct described by various Unani physicians. In this paper, a 10th century book, “Kamilussanah” authored by Ali ibn Abbas al-Majoosi, also known as Majoosi (930-994 CE), is reviewed through the prism of ethics.