Journal of Medical Ethics最新文献

There is a need for all industries, including healthcare, to reduce their greenhouse gas emissions. In anaesthetic practice, this not only requires a reduction in resource use and waste, but also a shift away from inhaled anaesthetic gases and towards alternatives with a lower carbon footprint. As inhalational anaesthesia produces greenhouse gas emissions at the point of use, achieving sustainable anaesthetic practice involves individual practitioner behaviour change. However, changing the practice of healthcare professionals raises potential ethical issues. The purpose of this paper is twofold. First, we discuss what moral duties anaesthetic practitioners have when it comes to practices that impact the environment. We argue that behaviour change among practitioners to align with certain moral responsibilities must be supplemented with an account of institutional duties to support this. In other words, we argue that institutions and those in power have second-order responsibilities to ensure that practitioners can fulfil their first-order responsibilities to practice more sustainably. The second goal of the paper is to consider not just the nature of second-order responsibilities but the content. We assess four different ways that second-order responsibilities might be fulfilled within healthcare systems: removing certain anaesthetic agents, seeking consensus, education and methods from behavioural economics. We argue that, while each of these are a necessary part of the picture, some interventions like nudges have considerable advantages.

This paper asks: If we are sufficientarians about health, then why do we care about health inequality? This is an important ethical question which should be of interest to moral philosophers as well as decision-makers, bureaucrats, and healthcare professionals. I present a generic account of health sufficientarianism and I argue that this account offers a distinctive and plausible explanation for our concern with health inequality. Central to my argument is the claim that the driver of our reasons for concern with social inequality in health is not the inequality per se, but the underlying risk of absolute health deficiency, and that this phenomenon is most directly explained by health sufficientarianism. This gives strengthened confidence in a sufficientarian approach to health justice.

Mitochondrial replacement therapy has been developed in order to prevent the transmission of mitochondrial mutations, yet it raises ethical concerns, particularly regarding the involvement of third-party DNA and the risks associated with donor procedures. This paper explores an alternative approach using synthetic DNA (synDNA) to construct mitochondrial organelles, thereby bypassing the need for donor oocytes and bypassing risks to donors. We argue that those who support mitochondrial replacement techniques as an ethically acceptable means of preventing the transmission of mitochondrial disease should consider the use of synthetic mitochondria as a preferable ethical alternative, should it prove technically viable. That this will be viable is more than we can demonstrate here. However, progress in synDNA technology suggests that it is not unreasonable to think that synthetic mitochondria creation is feasible, and perhaps even probable.

Semaglutide, sold under the brand names of Ozempic, Rybelsus and Wegovy, is one of the most popular drugs on the market. Manufactured by Novo Nordisk, semaglutide is the newest in a family of glucagon-like peptide-1 receptor agonists used most commonly to treat type II diabetes. To date, the results of semaglutide for the treatment of type II diabetes have been overwhelmingly positive. It is for the drug's effects on appetite suppression and weight loss, however, that have led its surge in popularity, with many hailing semaglutide as the new 'miracle drug for weight loss'. Despite its popularity, both the governmental and popular reception to the drug has largely been mixed. In this paper, we address a range of ethical concerns and argue that while many are legitimate, they do not provide conclusive reason not to prescribe semaglutide for weight loss.

In this paper, I argue for a subjectivity-first account of health-related adaptive preferences (HRAPs). Rather than evaluating preferences in isolation, this approach shifts normative attention to how a subject's lived orientation and the world they inhabit mutually shape one another long before a clinical encounter. On this view, the normative task is to understand how HRAPs become intelligible to a subject under non-ideal conditions by focusing on two dimensions of subject formation: the ecosystemic, which concerns the patterned norms and material conditions that structure what appears viable, and the configurational, which concerns how subjects interpret and navigate these pressures within their lived orientation. Together, these dimensions explain how HRAPs emerge in ways that avoid collapsing into either paternalism or relativism.

The moral right not to know (RNTK) is predominantly grounded in autonomy. This means that the scope, strength and nature of the moral RNTK is determined in light of the ethical principle of respect for autonomy. In this paper, I will further explore the relationship between patient autonomy and the scope of the RNTK in the context of treatment response monitoring. I focus on treatment response monitoring because novel challenges can be formulated against grounding the RNTK in autonomy in this context. I will consider three accounts of patient autonomy: Beauchamp and Childress' account of patient autonomy, Weimer's evidence-responsiveness condition for patient autonomy and Pugh's account of rational autonomy. Throughout the paper, I will illustrate the implications of these accounts of patient autonomy for the scope of the RNTK by asking which incidental findings (IFs) that arise during treatment response monitoring can be autonomously refused by metastatic breast cancer patients. I will conclude that although it becomes more difficult to autonomously refuse particular IFs on Weimer and Pugh's more demanding accounts of patient autonomy in the context of treatment response monitoring, they do not make it radically impossible to autonomously refuse any IF. Given the strength of the RNTK, this provides us with a strong reason to obtain, contrary to current clinical practice, patients' consent regarding the disclosure of IFs in the context of treatment response monitoring.

Recent advancements in organ procurement techniques to improve the quality of donated organs have given rise to normothermic regional perfusion (NRP), a procedure that restores blood flow to organs in patients who are declared dead by the circulatory standard. Arguments about NRP often refer to a troubling question: are NRP donors truly dead, or are they resuscitated?Such concerns about NRP draw parallels to the brain death debate: an issue that has attracted irreconcilable arguments about the nature of death. The resulting ideological gridlock seems to suggest that death is a metaphysical concept based on deeply rooted philosophical beliefs, and engaging in more intractable debates about the nature of death seems unfruitful for bioethics. In order to avoid repeating the mistakes of the brain death debate, metaphysical arguments about circulatory death should be framed under a new paradigm of metalinguistic dispute This paradigm considers how the concept of 'death' should be deployed usefully for NRP by evaluating the sociofunctional consequences of deploying death concepts for NRP while leaving the metaphysical question about death open.This paradigmatic shift from metaphysics to metalinguistics can help clinicians focus on clarifying the pragmatic and moral significance of declaring someone dead before undergoing NRP according to each patient's beliefs about death. A choice-based policy aligns with this goal by circumventing an ideological gridlock and avoiding the imposition of a single metaphysical conclusion about NRP on families with diverging beliefs about death.