Journal of Medical Ethics最新文献

Ingmar Persson and Julian Savulescu have argued that biomedical moral enhancement is a moral imperative. Others have argued that biomedical moral enhancement poses an unacceptable cost to freedom. I respond to freedom objections to biomedical moral enhancement by John Harris, Jonathan Pugh, Christoph Bublitz and Robert Sparrow both on their own terms and in terms of perfectionist freedom. At the very least, I seek to prove that biomedical moral enhancement is no more harmful to freedom than other forms of moral enhancement. At most, I seek to prove that moral enhancement increases freedom.

Dominant models of prioritising resources in intensive care unit (ICU) settings under conditions of severe resource scarcity, such as a pandemic, are likely to replicate and potentially exacerbate existing health inequities. One proposal is to advance equity by reserving a proportion of ICU resources, such as beds, for members of specific groups. This qualitative study explored the ethical acceptability of a reserve bed system (RBS) for healthcare workers and for indigenous Māori in the Aotearoa New Zealand context. Participants included Māori and non-Māori clinicians working in ICU settings, and non-clinical staff with expertise in ICU management and policy. Although there was a consensus on the urgency of addressing health inequities in New Zealand, especially for indigenous Māori, participants identified critical ethical challenges in implementing an RBS in the ICU setting. These findings contribute to the broader literature on the ethics of reserve systems for priority-setting.

Voinea, Porsdam Mann and Earp's article, 'Digital Twins or AI SIMs?', clarifies the terminology surrounding generative artificial intelligence (AI) systems that imitate individuals, proposing the concept of AI Simulation of an Individual Mind (AI SIM) to provide conceptual and ethical clarity. Building on this contribution, this commentary frames digital representations of individuals along a dynamic spectrum-from imitation, simulation, emulation to replication-that captures increasing technological sophistication and ethical complexity. Rather than offering a static taxonomy, this spectrum emphasises contextual nuance and adaptive, human-centric data and AI governance. While AI SIMs describe what these systems are, a spectrum-oriented approach helps illuminate what they may become and how they should be governed.

In this paper, we evaluate the ethical challenges faced by Muslim healthcare professionals (HCPs) working in palliative and end-of-life care (P&EOLC) in the UK. Aiming to contribute to an empirical foundation on which ethical support systems for religious HCPs can be built, we compare Islamic moral frameworks with the secular ethics of the NHS (National Health Service) and assess how Muslim HCPs navigate the integration of both.This qualitative study includes 76 semistructured interviews with Muslim patients, family members and a variety of Muslim and non-Muslim palliative care providers. Important themes were the central role of Islam, Islamic beliefs and values surrounding P&EOLC, and difficulties in navigating multiple moral frameworks resulting in significant moral distress among Muslim HCPs.Our study reveals a pressing need for better ethical support systems for religious HCPs and more inclusive workplaces in healthcare. We suggest developing ethical guidance incorporating religious perspectives, offering cultural and religious competence training to staff, and establishing peer support groups to aid Muslim HCPs in aligning their professional duties with their faith, preserving their integrity and well-being. We recommend future research focuses on gathering more empirical data from diverse Muslim populations, developing effective ethical support mechanisms and studying their impact.

In in vitro fertilisation (IVF) mix-ups and contested parenthood, Prince and colleagues argue that the familiar 'genetic presumption' in parenthood disputes should be treated as rebuttable in favour of the gestational relationship, and that custody and guardianship outcomes will typically be resolved under best-interests standards, with biological relatedness operating as one relevant factor among others. Their paper effectively re-centres moral attention on pregnancy, embodiment and gestation in a domain often organised around DNA and prior intention. This response agrees that gestation generates morally weighty interests and that a purely genetic default can obscure how parental bonds are formed and sustained.However, IVF mix-ups are a structurally distinctive category: they arise within an ex ante consent-based system of embryo creation, allocation and implantation, where predictability and institutional accountability are central. To preserve these values without collapsing into rigid geneticism, I propose a time-sensitive hybrid model. On this approach, genetic-intentional parenthood supplies the default entitlement at the point of error identification, reflecting the consent architecture of assisted reproduction, while settled attachment and caregiving reliance modify the remedy when discovery occurs late. The model thereby protects relational stability while preserving identity interests and institutional accountability, offering a temporally staged allocation framework that better fits assisted reproduction's underlying structure.

Some donor-conceived persons are born with an autosomal recessive genetic condition. In response, some fertility clinics categorically restrict the further use of the gametes from the donor who transmitted the pathogenic variant, although the chance of recurrence is usually very low. The level of specific risk that a recipient or physician is willing to accept depends on various factors, including severity, lived experiences and personal preferences. However, on a policy level, we argue for consistency and guidance on the principled question of whether the (further) use of gametes from donors who are carriers of a known pathogenic variant with autosomal recessive inheritance is acceptable. Provided that the identified risk is comparable to the general risk of genetic conditions, the continued use of the donor gametes can remain an acceptable option.

In debates over organ markets, the so-called best option argument is often invoked to oppose prohibition. The argument stresses that for some individuals, selling a kidney would be their best available option. In earlier work, I argued that this argument does comparatively little justificatory work under conditions of distributive injustice, because the option is best only through a narrow comparison that leaves out even better options required by justice. Hendricks has recently criticised this view, claiming that organ markets are always part of the best option, even once justice-satisfying measures are in place. In this reply, I argue that Hendricks's objection rests on a misunderstanding of the target and scope of my original argument. The disagreement is not about whether organ markets could coexist with justice, but about the justificatory significance of the best option argument under unjust background conditions.