Journal of Medical Ethics最新文献

Debates in bioethics and healthcare governance repeatedly confront communicative practices that smooth over uncertainty, ritualise consent or protect institutions more than they inform patients and professionals. These practices can be labelled 'bullshit', but the term is morally charged and analytically imprecise. This paper develops a diagnostic for truth-indifferent communication in healthcare that does not depend on inferring inner motives. By juxtaposing Frankfurt-style, Cohen-style and a Luhmannian approach, it shows how a systems-theoretical lens is especially useful for thinking through 'bullshit' as a structural and organisational phenomenon rather than an individual moral failure. Drawing on this perspective, the analysis focuses on observable proxies for truth-indifference: verification latency, incentive alignment, format and placement (eg, slogans or ritual reassurances), and the strength of sanction coupling. Informed consent serves as the central case for demonstrating how formalisation and nudging can both discipline and foster truth-indifferent communication. The result is a second-order, non-moralising framework that distinguishes functional from dysfunctional truth-indifferent communication and translates this distinction into concrete design and governance levers for bioethics and clinical practice.

Joona Räsänen argues that abortion is a paradigmatic 'transformative experience' and that such experiences weaken autonomy-based justifications for abortion because individuals cannot fully anticipate how either abortion or continued pregnancy will alter their future values and identities. This response challenges the legal implications of that claim. Transformative experiences are pervasive across medicine and ordinary life, yet legal standards of informed consent do not require predictive insight into future identity, only disclosure of material clinical risks and alternatives. Moreover, the epistemic uncertainty Räsänen highlights applies symmetrically to both abortion and childbirth, making it conceptually unsound to treat abortion as uniquely deficient in informed consent. Introducing heightened epistemic demands risks reinforcing antiabortion restrictions premised on assumed decisional incapacity. Rather than tightening consent requirements, a more defensible approach is to strengthen the structural conditions that enable meaningful reproductive choice. Uncertainty is not a threat to autonomy; it is a normal feature of human agency that legal doctrine already accommodates.

Unlike some critics of the dead donor rule, I do not defend consequentialism or deny the personhood of any potential organ donor. Instead, I argue that the principles of ethics and action theory that support the dead donor rule also prohibit widely accepted procedures, including kidney and partial liver transplants from living donors, fetal surgeries that permanently damage the uterus, sequential or domino liver transplants and lethal palliation. If physicians sometimes may cause death as a result of relieving a patient's pain, then they sometimes may cause death as a result of fulfilling the patient's desire to donate a vital organ.

One crucial issue that has historically received little attention within the assisted dying (AD) debate in the UK is what model of state involvement and provision should be implemented if AD becomes lawful. Limited attention has been paid to the question of whether AD should be positioned within existing end-of-life care provision, or whether it should occupy a separate space, with distinct provision. The question of the impact on the National Health Service (NHS) became an important point of concern in debates about the Terminally Ill Adults (End of Life) Bill 2024-2025. These debates raised questions concerning how lawful AD ought to be established, the financial cost of provision for the service which the Bill states must be free, and how best to safeguard the interests of both patients and healthcare professionals.We consider the Government's impact assessment, possible resource implications and ethical concerns over establishing a lawful AD service in England and Wales. The implications of a model of AD situated either within or alongside existing end-of-life NHS provision or, alternatively, established as a separate service outside existing end-of-life treatment provision are explored. We examine the key issues, including how AD should be funded, drawing on international experiences of different AD models. Our examination reveals that a clear volume/time/cost paradigm emerges, which must be recognised in planning a lawful AD service that avoids encouraging people towards AD. Whatever model of AD is implemented, maximising choice, safety, sustainability and equity of access are key concerns. Given the current NHS funding crisis, a variety of funding options to supplement state funding should be considered.

Conscience is typically invoked in healthcare to defend a right to conscientious objection, that is, the refusal by healthcare professionals to perform certain activities in the name of personal moral or religious views. On this approach, freedom of conscience should be respected when the individual is operating in a professional capacity. Others would argue, however, that a conscientious professional is one who can set aside one's own moral or religious views when they conflict with professional obligations. The debate on conscientious objection has by and large crystallised around these two positions, with compromise positions aiming at striking a balance between the two, for instance, by arguing for referral requirements by objecting healthcare professionals.In this article, I suggest that the debate on conscientious objection in healthcare could benefit from being reframed as a problem around demandingness rather than one about freedom of conscience and moral integrity. Being a professional, and a healthcare professional specifically, typically requires taking on additional burdens compared with non-professionals. For instance, healthcare professionals are expected to take on themselves higher risks than the rest of the population. However, it is also widely agreed that there are limits to the additional risks and burdens that healthcare professionals should be expected to take on themselves. Thus, a question worth exploring is whether, among the extra burdens that healthcare professionals should be expected to take on themselves as a matter of professional obligation, there is the burden of acting against one's own conscience.

The advances in machine learning (ML)-based systems in medicine give rise to pressing epistemological and ethical questions. Clinical decisions are increasingly taken in highly digitised work environments, which we call artificial epistemic niches. By considering the case of ML systems in life-critical healthcare settings, we investigate (1) when users' reliance on these systems can be characterised as epistemic dependence and (2) how this dependence turns into what we refer to as harmful epistemic dependence of clinical professionals on medical ML. The latter occurs when the impossibility of critically assessing the soundness of a system's output in situ implies a moral obligation to comply with its recommendation since a failure to do so constitutes a moral risk that cannot be justified then and there. We analyse the epistemic and moral consequences of harmful epistemic dependence on the status of medical professionals. We conclude by assessing how a suitable design of the epistemic niche can address the problem.