Journal of Medical Ethics最新文献

Objective: To study physicians' personal preferences for end-of-life practices, including life-sustaining and life-shortening practices, and the factors that influence preferences.

Design: A cross-sectional survey (May 2022-February 2023).

Setting: Eight jurisdictions: Belgium, Italy, Canada, USA (Oregon, Wisconsin, and Georgia), Australia (Victoria and Queensland).

Participants: Three physician types: general practitioners, palliative care physicians, and other medical specialists.

Main outcome measures: Percentage of physicians who preferred various end-of-life practices and provided information about influence on preferences and demographics.

Results: 1157 survey responses were analysed. Physicians rarely considered life-sustaining practices a (very) good option (in cancer and Alzheimer's respectively: cardiopulmonary resuscitation, 0.5% and 0.2%; mechanical ventilation, 0.8% and 0.3%; tube feeding, 3.5% and 3.8%). About half of physicians considered euthanasia a (very) good option (respectively, 54.2% and 51.5%). The proportion of physicians considering euthanasia a (very) good option ranged from 37.9% in Italy to 80.8% in Belgium (cancer scenario), and 37.4% in Georgia, USA to 67.4% in Belgium (Alzheimer's scenario). Physicians practising in a jurisdiction with a legal option for both euthanasia and physician-assisted suicide were more likely to consider euthanasia a (very) good option for both cancer (OR 3.1, 95% CI 2.2 to 4.4) and Alzheimer's (OR 1.9, 95% CI 1.4 to 2.6).

Conclusion: Physicians largely prefer to intensify alleviation of symptoms at the end of life and avoid life-sustaining techniques. In a scenario of advanced cancer or Alzheimer's disease, over half of physicians prefer assisted dying. Considerable preference variation exists across jurisdictions, and preferences for assisted dying seem to be impacted by the legalisation of assisted dying within jurisdictions.

Building a biobank network in developing countries is essential to foster genomic research and precision medicine for patients' benefit. However, there are serious barriers to establishing biobanks in low-income and middle-income countries (LMICs), including Ukraine. Here, we outline key barriers and essential milestones for the successful expansion of biobanks, genomic research and personalised medicine in Ukraine, drawing from the experience of other LMICs. A lack of legal and ethical governance in conjunction with limited awareness about biobanking and community distrust are the principal threats to establishing biobanks. The experiences of LMICs suggest that Ukraine urgently needs national guidelines covering ethical and legal aspects of biospecimen-related research. National guidelines must be consistent with international ethical recommendations for safeguarding participants' rights, welfare and privacy. Additionally, efforts to educate and engage physicians and patient communities are essential for achieving biobanking goals and benefits for precision medicine and future patients.

Given that only a small fraction of patients with cancer exhibits specific markers making them eligible for effective targeted therapies, this paper investigates the justification of treating cancer differently in terms of resource allocation when it comes to the application of novel precise therapies-the so-called onco-exceptionalism. Specifically, it assesses whether the reimbursement of expensive drugs is equitable. To do so, we first contextualise healthcare resource allocation concerning immunotherapeutic treatments for cancer, then explore arguments for and against onco-exceptionalism and finally conclude by advocating for a proactive health approach.

In this short paper, I detail a case against Dr Guido Pennings's latest publication in the Journal of Medical Ethics, titled 'The moral obligation to have genetically related children". I argue that Pennings, despite raising awareness of issues of bioethical and scientific import, fatally neglects to interact with a central debate in reproductive ethics: the non-identity problem (NIP). Taking the NIP seriously, we can see that the moral obligation that Pennings argues for falls victim to the same kinds of issues as the principle of procreative beneficence, which Pennings also cites. This response then considers the possibility of damaging upshots if Pennings's arguments were read uncritically.

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.

Colgrove and Rodger argue that the case advanced by Smajdor and Räsänen for classifying pregnancy as a disease can be defeated by an existence proof-that is, by identifying at least one plausible theory of disease that excludes pregnancy while avoiding objections raised by Smajdor and Räsänen. Their candidate is a dysfunction account, according to which a disease requires the failure of some internal mechanism to perform its biological function. Pregnancy, they claim, involves no such failure. Even if one accepts the legitimacy of this dialectical strategy, the proposed exclusion is not as simple as advertised. In particular, the exclusion is obtained by narrowing the target phenomenon and by treating the concept of 'proper function' as if it had a determinate, value-free extension-one that it in fact does not possess. Since the apparent dialectical effect of an imperfect rebuttal can be to strengthen rather than weaken the target of criticism, I find it worth responding to both pieces in a single, joined-up analysis, which I aim to present here.

Compared with high-income countries (HICs), developing 'Chat-IRB'-application-specific large language models for research ethics review-may have different implications for resource-constrained Research Ethics Committees or Institutional Review Boards (IRBs) in low- and middle-income countries (LMICs). While certain concerns raised by Moodley, Malpani, and Reis-including resource challenges, reviewing research conducted in LMICs, and automation bias-are not entirely unique to LMIC IRBs, the hurdles they must overcome in developing a contextualised Chat-IRB will likely be greater. Crucially, Chat-IRB for LMICs presents a significant opportunity to strengthen ethics capacity and bolster oversight through: (1) stimulating greater investment in generating open-access, LMIC-centred research ethics scholarship that also serves as training data; (2) leveraging existing WHO or UNESCO programmes to develop an 'always available' training resource and review tool should international funding for ethics education and capacity-building be reduced or withdrawn; (3) mitigating inadequate human capacities by providing a 'minimal acceptable standard' of review, especially during time-sensitive matters; and (4) a national-level Chat-IRB as a centralised 'governance' mechanism and first-line defence against ethics dumping, IRB shopping, and other exploitative research practices. Taken holistically, purpose-built for LMICs, Chat-IRB represents a critical-but potentially unrecognised-opportunity for HICs to advance ethics capacity-building, and strengthen research oversight within LMICs.

In 2025, an Australian couple asked to have their remaining embryos moved to another clinic, only to discover that the child they had birthed 2 years earlier had not come from their own embryos, but an embryo belonging to a different couple. These situations can lead to disputes about who is recognised as 'the parents' in the biological or social sense, as well as who has moral or legal claims to parental rights and responsibilities. In terms of specific legal disputes over custody or guardianship, the matter will generally be resolved in the best interests of the child. However, one of the considerations relevant to this child's best interests is the question of biological relatedness, even if only due to the social weight it is often granted. This paper will argue that the current presumption in favour of genetics as determinative of biological relatedness is rebuttable in favour of the gestational relationship. Furthermore, there are other reasons to give weight to the moral, legal, or social claims of the gestational progenitors, such as bonds with the infant that have already been developed. However, such mix-ups will happen again and, in light of genomic technologies, may be discovered in vivo or immediately after birth, in which the courts may be ill-suited to determining the best interests. As such, legislative approaches to resolving parenthood in such cases must be proactively developed.

Gyngell et al argue that no intrinsic differences exist between embryos derived from fertilisation and stem cell-derived embryo models (SCEMs) that would justify attributing a higher moral status to the former. Nienke de Graeff and Lien De Proost challenge this claim by emphasising the diversity of SCEMs and by broadening moral evaluation beyond direct moral status to include relational, symbolic and instrumental value. This response argues that their pluralistic framework does not, in fact, undermine moral equivalence in cases where SCEMs successfully instantiate embryo-like human developmental organisation. Once the distinction between properties that ground moral status and considerations that merely shape social or regulatory responses is made explicit, no principled basis remains for differential moral standing. Variation among SCEMs defeats equivalence only where embryo-like organisation is absent; where it is present, moral parity follows. Likewise, relational and instrumental values may justify different governance strategies, but they cannot ground differences in moral worth without collapsing into policy convenience. Rejecting binary thinking does not require denying equivalence where morally relevant features coincide. Either SCEMs fail to model embryos, in which case equivalence never arises, or they succeed and must be treated as morally equivalent in respect of status. What cannot be coherently sustained is embryo-likeness without moral parity.