Journal of Medical Ethics最新文献

When the clinician and patient are unable to reconcile differences over treatment, does this mean the latter lacks capacity to decide in such matters? Wellesley et al analyse the legal judgements in the case of Ms Sudiksha Thirumalesh where, on the particulars, the Court of Protection answered yes, only for the Court of Appeal to disagree. The authors highlight concerns about using isolated false belief as an indicator of incapacity and advise that such matters may be better resolved by greater discussion of the benefits and burdens of treatment, alongside consideration of their costs. Here, I suggest that a disability perspective is also helpful to such cases, recognising that this was a disagreement from which the patient couldn't walk away. Disability means that particular care is required when considering the burdens and benefits of treatment as these may vary widely in the eye of the beholder. Second, the costs of litigation are particularly high when a disabled person, with life-limiting illness, is left feeling they are using precious time and energy arguing for their existence. Third, any such legal judgments ought to make clear what reasonable adjustments have been offered to include the disabled person in proceedings. Fourth, and relatedly, such disputes should be attentive to the significant risk of epistemic injustice, where disabled patients find themselves less believed, in part because the 'able-bodied' have not shared their experiences. Together, these considerations (i) add to the call made by Wellesley et al for better discussions and (ii) suggest that early involvement of Rehabilitation Medicine, with expertise in disability and related ethics, could offer an important means to reduce the need for such litigation in the future.

Medical ethics and law (MEL) have a well-established place in medical curricula within the UK, but appropriately assessing MEL in a medical school context can be extremely challenging. The Institute of Medical Ethics convened a working group focused on assessment in 2021, and in this article, we present a summary of the work undertaken by this group. We start by explaining the challenges presented by the assessment of MEL, highlighting the potentially demanding requirements set out by the General Medical Council in the UK. We then explore how MEL is currently assessed in UK medical schools. We go on to consider a number of different forms of assessment and their suitability for assessing ethics and law. Finally, we report the key recommendations from the working group and conclude that we are unconvinced that current approaches to assessing MEL are sufficient to robustly assess the General Medical Council's learning outcomes.

In the UK, the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a widely used process, designed to facilitate shared decision-making between a clinician and a patient or, if the patient lacks capacity to participate in the conversation, a person close to the patient. A key outcome of the ReSPECT process is a set of recommendations, recorded on the patient-held ReSPECT form, that reflect the conversation. In an emergency, these recommendations are intended to inform clinical decision-making, and thereby enable the attending clinician-usually a general practitioner (GP) or paramedic-to act in the patient's best interests. This study is the first to explore the extent to which ReSPECT recommendations realise their goal of informing best interests decision-making in community contexts. Using a modified framework analysis approach, we triangulate interviews with patients and their relatives, GPs and nurses and care home staff. Our findings show that inconsistent practices around recording patient wishes, diverging interpretations of the meaning and authority of recommendations and different situational contexts may affect the interpretation and enactment of ReSPECT recommendations. Enacting ReSPECT recommendations in an emergency can be fraught with complexity, particularly when attending clinicians need to interpret recommendations that did not anticipate the current emergency. This may lead to decision-making that compromises the patient's best interests. We suggest that recording patients' values and preferences in greater detail on ReSPECT forms may help overcome this challenge, in providing attending clinicians with richer contextual information through which to interpret treatment recommendations.

In this paper, we take a data-driven approach to analyse intellectual trends over the first five decades of the Journal of Medical Ethics (JME). Our data set, comprising all texts published in the JME since 1975, reveals not only the most distinctive topics of the JME in comparison to other key journals with similar profiles but also diachronic fluctuations in the prominence of certain topics. Overall, the distribution of topics shifted gradually, with each editorial period at the JME showing continuity with its immediate predecessor. However, a significant drift in topic distribution is evident over the 50 years, with some editorial periods being more 'disruptive' than others. These disruptions were influenced by external events (eg, Public health emergencies), broader trends in bioethics (eg, the recent growth of topics such as Race, Privacy and Vaccination) or editors' preferences (eg, Ethics education). Additionally, our data provides insights into editorials where editors outlined their visions for the journal or reflected retrospectively on their past editorship.

In a recent article, Haining et al outline several ethical and regulatory considerations for polygenic risk scores (PRSs), which may expand current embryonic screening to include polygenic diseases and non-disease traits. I argue in this response that the authors overlook a few crucial issues that nations should address. For adult-onset diseases, regulations must not only account for predictive accuracy of PRSs but also establish the precise circumstances that warrant testing-such as a disease's severity and the average age at which symptoms manifest. I later stress the need for more consideration of how to educate patients on manageable diseases that their embryos are at risk of later developing. Required information must correct social biases without compromising genetic counsellors' impartiality. Drawing on global approaches to other embryonic genetic tests, I advocate for frameworks that protect patients' autonomy while addressing the unique uncertainties posed by PRSs.