Journal of Medical Ethics最新文献

Iatrogenesis is a recognised aspect of healthcare. But could kindness, a prized ingredient in such work, be implicated in some of the iatrogenic harm? In a recent paper, I noted how healthcare professionals and institutions that appear to value and vaunt kindness can, in practice, fall not just occasionally short, but often systemically so. Rather than insisting on these as aberrations, I wondered whether, our practice of kindness may, as with use of antibiotics or X-rays, have its own less considered but nonetheless harmful side effects. Here, encouraged by the resulting interest, I reflect further, including on two quite different responses to my paper from Cheung, and from Tan and Neo. In some aspects, we hold common ground. Cheung agrees the discretionary nature of kindness can pose ethical problems. Moreover, none of us are arguing kindness should be abandoned, cannot be virtuous, is merely favouritism, or forms the sole or proven cause of healthcare failures. Cheung suggests we infuse our practice with curiosity, reducing harms from discretionary kindness. Tan and Neo appear reluctant to concede such harms. They argue kindness is protected against these, including by its virtuous nature. Seasoned doubters might respond 'the road to hell is paved with good intentions'. In real-world conditions, when healthcare professionals and their institutions profess kindness but behave differently, is it sufficient for our learning simply to condemn them as unvirtuous? Cautiously, we could be more curious. We could ask if, by offering kindness to those close around them, this carries the side effect of depriving others, people perhaps wider afield and less considered.

While artificial intelligence's (AI's) potential role in enhancing diagnostic accuracy and personalising treatment is well-recognised, its application in evaluating physicians raises critical ethical concerns as well. The paper examines the impact of AI on the 'comparative abilities' exception to informed consent, which currently exempts physicians from disclosing information about the performance of other providers. With AI's ability to generate granular, accurate comparisons of physician metrics, this exception will be challenged, potentially empowering patients to make more informed decisions. However, AI's use in disclosing physician success rates may exacerbate healthcare disparities, as wealthier patients may have more access to higher-skilled providers. Policymakers and ethicists must proactively address these concerns to ensure equitable access to care as AI technologies advance.

Some pro-life philosophers have argued that if one accepts abortion, one should accept infanticide. Prabhpal Singh has proposed a symmetry breaker. He argues that the parent-child relationship can only be obtained between born humans and such a relationship entails that infanticide is wrong. I consider this account and argue that not only is its central claim, that only born humans can stand in a parent-child relationship, unmotivated, but even if accepted, it would still not explain why infanticide is wrong.

Informed consent in surgical settings requires not only the accurate communication of medical information but also the establishment of trust through empathic engagement. The use of large language models (LLMs) offers a novel opportunity to enhance the informed consent process by combining advanced information retrieval capabilities with simulated emotional responsiveness. However, the ethical implications of simulated empathy raise concerns about patient autonomy, trust and transparency. This paper examines the challenges of surgical informed consent, the potential benefits and limitations of digital tools such as LLMs and the ethical implications of simulated empathy. We distinguish between active empathy, which carries the risk of creating a misleading illusion of emotional connection and passive empathy, which focuses on recognising and signalling patient distress cues, such as fear or uncertainty, rather than attempting to simulate genuine empathy. We argue that LLMs should be limited to the latter, recognising and signalling patient distress cues and alerting healthcare providers to patient anxiety. This approach preserves the authenticity of human empathy while leveraging the analytical strengths of LLMs to assist surgeons in addressing patient concerns. This paper highlights how LLMs can ethically enhance the informed consent process without undermining the relational integrity essential to patient-centred care. By maintaining transparency and respecting the irreplaceable role of human empathy, LLMs can serve as valuable tools to support, rather than replace, the relational trust essential to informed consent.

'Live tissue training', using an anaesthetised live animal substituted for a human patient for the practice of surgical skills, is a controversial topic. Although simulator technologies have developed significantly for inclusion in many areas of surgical education, it is contested that training to manage traumatic injuries requires a model that can bleed and has a dynamic circulation. This article uses the published literature to explore the values at stake regarding live tissue training in the context of trauma with the aim of considering whether such training is ethically justifiable, to any degree. We present criteria for the ethical evaluation of live animal use in trauma simulation alongside descriptions of the pro- and contra-arguments present in the literature. Our conclusion is that justification is challenging and must be considered on a case-by-case basis-it is important that the difference gained from using a live animal compared with the best alternative simulator has to be greater than the clear ethical downside of using animals.

Background: 'The Clinical Ethics Advisory Group' (CEAG) is the clinical ethics support body for Newcastle upon Tyne Hospitals National Health Service Foundation Trust. A significant change in CEAG's way of working occurred over the past 5 years as a result of Court decisions, increasing public expectations and an increase in CEAG's paediatric case flow.

Purpose: Review historical data: (a) as a useful benchmark to look for the early impact of significant service changes and (b) to seek possible reference ('sentinel') cases for use with a posited practical (casuistic) case-based reasoning model.

Methods: Audit of the minutes of the first 22 years' meetings was undertaken by the two chairs of CEAG over that period of time.

Results: 223 matters discussed: 86 Trust policy issues; 117 clinical cases (84 adult (32 urgent), 33 child (8 urgent)); 12 CEAG procedural issues and 8 UK Clinical Ethics Network 'round robin' cases. The range of topic areas was wide. A broad range of ethical structures were deployed, principlism predominated. Quality was subjectively assessed by each reviewer, but different methods were used. This proved highly concordant between the two reviewers. 47% (105/223) of discussions were 'excellent' (*A4C4-A4C4) and 70% (156.5/223) 'good' or better (*A4C4-A3C3). By meeting the criteria of 'excellent' and 'prospective', 92/223 (41%) of matters were deemed potentially suitable as sentinel cases.

Conclusions: The audit provides a rich vein of information. There is demand for CEAG's services, workload is becoming more complex. Formal funding for such services seems justified.

Healthcare is one of the domains in which artificial intelligence (AI) is already having a major impact. Of interest is the idea of the digital twin (DT), an AI-powered technology that generates a real-time representation of the patient's body, offering the possibility of more personalised care. Our main thesis in this paper is that the DT does not merely represent the patient's body but produces a specific body. We argue, from a philosophical perspective and an ethical-phenomenological approach, that the virtual body created by the DT has a major impact on one's self-understanding, having consequences for gender expression and identification, and for health. This has deep implications for people who do not conform to gender normativity, for example, trans individuals. We advocate that, with thoughtful development, DT technology can and should be empowering, contributing to better addressing the diversity of bodies and facilitating trans people's experience in healthcare contexts.

This paper asks how bioethics navigates, and should navigate, value pluralism in the increasingly global spaces in which bioethics operates. We juxtapose the ethical approaches suggested by East Asian societies, drawing primarily on Confucian ethics, with approaches more prevalent in Western societies, especially North America and Western Europe. Drawing on the Confucian virtue of li () (ritual propriety and decorum), we argue for greater tolerance, respect, epistemic justice, cultural humility and civility. We show how to translate these values into practice using the examples of international bioethics policies governing abortion practice, artificial intelligence governance and climate change. The 'Introduction' section raises the question of how to engage in bioethics across borders. The section, 'Leading Views of Bioethics are WEIRD' explores how the field of bioethics currently navigates value pluralism. It characterises leading bioethics approaches as WEIRD-Western, educated, industrialised, rich and democratic. The section, 'East Asian and Western Views of Personhood' illustrates WEIRD approaches, juxtaposing Eastern and Western accounts of personhood in three cases: social robots, prenatal human life, and nature. The section, 'Epistemic Justice and Value Pluralism' argues that bioethics' WEIRDness violates epistemic justice by assigning excess credibility to the West while deflating the credibility of the East. We propose a pluriversal alternative and apply it to bioethics practice by drawing on the Confucian virtue of li The paper concludes that bioethicists should embrace a pluriversal approach to global value diversity.